- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $9,549.93
| Facility | | $3,162.28 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $2,951.21
| Professional | | $912.01 | $1,122.02 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $2,818.38
| Professional | | $977.24 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $4,365.16
| Facility | | $851.14 | $851.14 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,698.24 / $2,884.03
| Professional | | $831.76 | $1,698.24 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,412.54 / $2,041.74
| Professional | | $870.96 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,495.41 / $9,332.54
| Facility | | $2,630.27 | $5,495.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,479.11 / $2,818.38
| Professional | | $691.83 | $1,479.11 | $2,818.38 |