- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,120.11 / $16,218.10
| Facility | | $3,981.07 | $9,120.11 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,023.29 / $3,388.44
| Professional | | $338.84 | $1,023.29 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $17,378.01 / $25,703.96
| Facility | | $8,709.64 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $3,630.78
| Professional | | $371.54 | $537.03 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,096.48 / $4,365.16
| Professional | | $467.74 | $1,096.48 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,548.13
| Professional | | $3,467.37 | $3,467.37 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $18,620.87
| Facility | | $7,244.36 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,862.09 / $4,897.79
| Professional | | $407.38 | $1,862.09 | $4,897.79 |