- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,079.46 / $16,982.44
| Facility | | $1,819.70 | $7,079.46 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $1,479.11
| Professional | | $812.83 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $14,125.38 / $28,840.32
| Facility | | $5,370.32 | $14,125.38 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $1,905.46
| Professional | | $660.69 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $16,595.87 / $38,018.94
| Facility | | $7,079.46 | $16,595.87 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,754.40 / $5,754.40
| Professional | | $1,584.89 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $2,951.21
| Professional | | $1,148.15 | $1,621.81 | $2,951.21 |