- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $18,620.87
| Facility | | $4,570.88 | $8,511.38 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,659.59 / $3,801.89
| Professional | | $436.52 | $1,659.59 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $19,498.45 / $31,622.78
| Facility | | $8,912.51 | $19,498.45 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $2,344.23 / $5,128.61
| Professional | | $724.44 | $2,344.23 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,548.82 / $5,370.32
| Professional | | $645.65 | $1,548.82 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $4,466.84
| Professional | | $3,630.78 | $3,630.78 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $21,877.62
| Facility | | $8,912.51 | $12,589.25 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $2,238.72 / $6,165.95
| Professional | | $501.19 | $2,238.72 | $6,165.95 |