- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,888.44 / $10,964.78
| Facility | | $3,467.37 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,737.80 / $3,890.45
| Professional | | $426.58 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,135.61 / $16,595.87
| Facility | | $8,317.64 | $15,135.61 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $4,570.88
| Professional | | $602.56 | $831.76 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,949.84 / $5,623.41
| Professional | | $426.58 | $1,949.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,630.27 / $3,981.07
| Professional | | $1,584.89 | $2,630.27 | $3,981.07 |
- 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
- $436.52 / $1,819.70 / $3,801.89
| Professional | | $436.52 | $1,819.70 | $3,801.89 |