- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,908.39 / $8,587.98 / $24,427.40
| Facility | | $3,908.39 | $8,587.98 | $24,427.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.73 / $2,442.73 / $2,826.60
| Professional | | $2,442.73 | $2,442.73 | $2,826.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,740.44 / $6,379.04 / $13,609.56
| Facility | | $5,740.44 | $6,379.04 | $13,609.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.85 / $2,268.25 / $2,268.26
| Professional | | $1,395.85 | $2,268.25 | $2,268.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,301.23 / $12,756.79 / $15,308.49
| Facility | | $6,301.23 | $12,756.79 | $15,308.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,489.63 / $4,736.13 / $10,770.74
| Professional | | $3,489.63 | $4,736.13 | $10,770.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.64 / $2,093.78 / $2,093.78
| Professional | | $1,465.64 | $2,093.78 | $2,093.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $2,750.00 / $3,500.00
| Professional | | $2,500.00 | $2,750.00 | $3,500.00 |