- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $14,125.38
| Facility | | $4,570.88 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $1,412.54
| Professional | | $933.25 | $1,318.26 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $26,915.35
| Facility | | $8,912.51 | $17,378.01 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $2,398.83
| Professional | | $1,148.15 | $1,412.54 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $1,659.59
| Facility | | $851.14 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $478.63 / $1,318.26
| Professional | | $416.87 | $478.63 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,511.38 / $11,748.98
| Facility | | $5,370.32 | $8,511.38 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $1,862.09
| Professional | | $588.84 | $1,000.00 | $1,862.09 |