- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,595.87
| Facility | | $2,041.74 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $741.31
| Professional | | $407.38 | $575.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $8,511.38 / $17,378.01
| Facility | | $4,073.80 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,000.00 / $1,995.26
| Professional | | $512.86 | $1,000.00 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $16,595.87 / $38,018.94
| Facility | | $6,918.31 | $16,595.87 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $2,754.23
| Professional | | $794.33 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $28,840.32
| Facility | | $3,630.78 | $12,022.64 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $1,445.44
| Professional | | $549.54 | $812.83 | $1,445.44 |