- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $10,715.19
| Facility | | $2,754.23 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $2,344.23
| Professional | | $891.25 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $9,332.54 / $17,378.01
| Facility | | $4,786.30 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,318.26 / $1,819.70
| Professional | | $1,023.29 | $1,318.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $1,862.09
| Professional | | $1,071.52 | $1,412.54 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,202.26 / $3,630.78
| Professional | | $1,174.90 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $933.25
| Professional | | $851.14 | $851.14 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $12,882.50
| Facility | | $2,630.27 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $2,454.71
| Professional | | $1,096.48 | $1,412.54 | $2,454.71 |