- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,370.32 / $10,715.19
| Facility | | $3,090.30 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $1,905.46
| Professional | | $660.69 | $776.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,197.01 / $33,113.11
| Facility | | $11,481.54 | $18,197.01 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $1,230.27
| Professional | | $691.83 | $891.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,288.25
| Professional | | $741.31 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $2,570.40 / $2,570.40
| Professional | | $891.25 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $630.96 / $645.65
| Professional | | $616.60 | $630.96 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $12,882.50
| Facility | | $2,630.27 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,698.24
| Professional | | $776.25 | $977.24 | $1,698.24 |