- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,120.11 / $10,715.19
| Facility | | $6,606.93 | $9,120.11 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,365.16 / $6,918.31
| Professional | | $3,630.78 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $3,311.31 / $8,709.64
| Professional | | $66.07 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,471.29 / $13,182.57
| Facility | | $7,079.46 | $10,471.29 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Professional | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,606.93 / $26,302.68
| Facility | | $4,786.30 | $6,606.93 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $27,542.29
| Professional | | $2,290.87 | $3,311.31 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $6,606.93
| Facility | | $2,290.87 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $6,025.60
| Professional | | $2,290.87 | $3,311.31 | $6,025.60 |