- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,025.60 / $10,964.78
| Facility | | $3,890.45 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $2,884.03
| Professional | | $912.01 | $1,071.52 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $26,915.35
| Facility | | $8,912.51 | $17,378.01 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,041.74 / $2,884.03
| Professional | | $954.99 | $2,041.74 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $9,549.93
| Facility | | $1,047.13 | $1,047.13 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $2,818.38
| Professional | | $1,230.27 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,513.56 / $1,949.84
| Professional | | $977.24 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,964.78 / $18,620.87
| Facility | | $7,244.36 | $10,964.78 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $2,754.23
| Professional | | $912.01 | $1,548.82 | $2,754.23 |