- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $10,715.19
| Facility | | $2,754.23 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $870.96 / $1,862.09
| Professional | | $776.25 | $870.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $20,417.38 / $38,904.51
| Facility | | $14,125.38 | $20,417.38 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $1,905.46
| Professional | | $933.25 | $1,230.27 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $7,079.46 / $22,387.21
| Facility | | $1,445.44 | $7,079.46 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,148.15 / $1,819.70
| Professional | | $870.96 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $3,311.31
| Professional | | $794.33 | $1,148.15 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,288.25
| Professional | | $794.33 | $794.33 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $13,803.84 / $20,417.38
| Facility | | $10,471.29 | $13,803.84 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,148.15 / $2,089.30
| Professional | | $870.96 | $1,148.15 | $2,089.30 |