- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,079.46 / $11,481.54
| Facility | | $4,365.16 | $7,079.46 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $6,456.54 / $9,549.93
| Professional | | $794.33 | $6,456.54 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,413.10 / $16,218.10
| Facility | | $2,511.89 | $7,413.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,348.96 / $2,290.87
| Professional | | $1,122.02 | $1,348.96 | $2,290.87 |
- 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
- $12,589.25 / $16,595.87 / $23,988.33
| Professional | | $12,589.25 | $16,595.87 | $23,988.33 |
- 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
- $707.95 / $1,071.52 / $28,840.32
| Professional | | $707.95 | $1,071.52 | $28,840.32 |