- 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
- $575.44 / $724.44 / $1,995.26
| Professional | | $575.44 | $724.44 | $1,995.26 |
- 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
- $562.34 / $1,230.27 / $1,698.24
| Professional | | $562.34 | $1,230.27 | $1,698.24 |
- 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
- $831.76 / $1,202.26 / $1,862.09
| Professional | | $831.76 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $1,412.54
| Professional | | $707.95 | $1,096.48 | $1,412.54 |
- 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
- $575.44 / $977.24 / $1,819.70
| Professional | | $575.44 | $977.24 | $1,819.70 |