- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,456.54 / $14,791.08
| Facility | | $1,949.84 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $6,456.54 / $9,332.54
| Professional | | $794.33 | $6,456.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $11,748.98 / $28,840.32
| Facility | | $5,754.40 | $11,748.98 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $812.83 / $3,388.44
| Professional | | $371.54 | $812.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $33,884.42 / $89,125.09
| Facility | | $12,022.64 | $33,884.42 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $14,454.40 / $16,982.44
| Professional | | $13,489.63 | $14,454.40 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $28,183.83
| Facility | | $3,630.78 | $12,022.64 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,071.52 / $11,481.54
| Professional | | $645.65 | $1,071.52 | $11,481.54 |