- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $9,549.93
| Facility | | $3,162.28 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $1,479.11
| Professional | | $467.74 | $602.56 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $1,174.90
| Professional | | $467.74 | $1,023.29 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $1,380.38
| Professional | | $537.03 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $870.96
| Professional | | $776.25 | $776.25 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,709.64 / $11,748.98
| Facility | | $5,754.40 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $1,548.82
| Professional | | $501.19 | $794.33 | $1,548.82 |