- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,623.41 / $7,413.10
| Facility | | $3,801.89 | $5,623.41 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $4,168.69 / $6,456.54
| Professional | | $616.60 | $4,168.69 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,760.83 / $14,454.40
| Facility | | $2,290.87 | $6,760.83 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,096.48 / $1,819.70
| Professional | | $912.01 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $16,595.87 / $16,595.87
| Facility | | $15,488.17 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,135.61 / $21,877.62
| Professional | | $11,481.54 | $15,135.61 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $9,120.11 / $19,498.45
| Facility | | $2,290.87 | $9,120.11 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $891.25 / $25,703.96
| Professional | | $478.63 | $891.25 | $25,703.96 |