- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,431.10 / $6,739.33 / $15,379.80
| Facility | | $4,431.10 | $6,739.33 | $15,379.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,571.84 / $4,431.10 / $4,717.53
| Professional | | $3,571.84 | $4,431.10 | $4,717.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.71 / $9,889.96 / $16,679.84
| Facility | | $461.71 | $9,889.96 | $16,679.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,198.77 / $2,857.03 / $4,447.95
| Professional | | $2,198.77 | $2,857.03 | $4,447.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,380.56 / $18,686.74 / $38,681.57
| Facility | | $4,380.56 | $18,686.74 | $38,681.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,750.23 / $12,279.06 / $16,646.15
| Professional | | $7,750.23 | $12,279.06 | $16,646.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,830.52 / $4,043.60 / $11,826.85
| Professional | | $2,830.52 | $4,043.60 | $11,826.85 |