- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $9,549.93
| Facility | | $2,754.23 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,380.38 / $2,754.23
| Professional | | $416.87 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $14,125.38 / $16,595.87
| Facility | | $7,943.28 | $14,125.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,584.89 / $4,265.80
| Professional | | $645.65 | $1,584.89 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,137.96 / $4,168.69
| Professional | | $691.83 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,630.78 / $11,748.98
| Professional | | $3,162.28 | $3,630.78 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,471.29 / $16,218.10
| Facility | | $6,456.54 | $10,471.29 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,659.59 / $3,890.45
| Professional | | $512.86 | $1,659.59 | $3,890.45 |