- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $7,943.28 / $16,595.87
| Facility | | $1,288.25 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,096.48 / $1,949.84
| Professional | | $912.01 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,912.51 / $16,595.87
| Facility | | $3,715.35 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $1,949.84
| Professional | | $831.76 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $2,089.30
| Professional | | $933.25 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,187.76
| Facility | | $1,000.00 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,182.57 / $23,442.29
| Facility | | $5,128.61 | $13,182.57 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $2,238.72
| Professional | | $912.01 | $1,258.93 | $2,238.72 |