- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,850.54 / $8,460.87 / $24,065.90
| Facility | | $3,850.54 | $8,460.87 | $24,065.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,406.59 / $2,406.59 / $2,784.77
| Professional | | $2,406.59 | $2,406.59 | $2,784.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,655.48 / $6,284.63 / $13,408.12
| Facility | | $5,655.48 | $6,284.63 | $13,408.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.33 / $2,234.67 / $2,234.69
| Professional | | $325.33 | $2,234.67 | $2,234.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,843.76 / $10,793.55 / $12,568.85
| Facility | | $7,843.76 | $10,793.55 | $12,568.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,437.98 / $4,666.03 / $10,611.33
| Professional | | $3,437.98 | $4,666.03 | $10,611.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.95 / $2,062.79 / $3,437.98
| Professional | | $1,443.95 | $2,062.79 | $3,437.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,750.00 / $2,920.00 / $3,000.00
| Professional | | $2,750.00 | $2,920.00 | $3,000.00 |