- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,467.37 / $5,888.44
| Facility | | $2,398.83 | $3,467.37 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $4,786.30 / $7,585.78
| Professional | | $616.60 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $17,378.01
| Facility | | $7,943.28 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,413.10 / $9,332.54
| Professional | | $5,754.40 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $19,952.62 / $20,892.96
| Facility | | $18,620.87 | $19,952.62 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $12,302.69 / $12,302.69
| Professional | | $602.56 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,309.57 / $14,791.08
| Facility | | $3,715.35 | $6,309.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $851.14 / $15,488.17
| Professional | | $426.58 | $851.14 | $15,488.17 |