- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,762.47 / $8,912.51
| Facility | | $2,089.30 | $7,762.47 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $8,128.31 / $9,120.11
| Professional | | $794.33 | $8,128.31 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $34,673.69 / $56,234.13
| Facility | | $15,488.17 | $34,673.69 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $6,309.57
| Professional | | $60.26 | $60.26 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $19,054.61
| Facility | | $2,398.83 | $2,398.83 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $21,379.62 / $79,432.82
| Facility | | $1,659.59 | $21,379.62 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,778.28
| Professional | | $676.08 | $977.24 | $1,778.28 |