- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,897.79 / $8,511.38
| Facility | | $2,691.53 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,096.48 / $3,090.30
| Professional | | $316.23 | $1,096.48 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $37,153.52 / $37,153.52
| Facility | | $37,153.52 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,949.84 / $4,786.30
| Professional | | $549.54 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $912.01 / $4,265.80
| Professional | | $398.11 | $912.01 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $12,882.50
| Professional | | $2,344.23 | $3,311.31 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,513.56 / $3,981.07
| Professional | | $346.74 | $1,513.56 | $3,981.07 |