- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,606.93 / $16,982.44
| Facility | | $2,570.40 | $6,606.93 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $15,135.61
| Professional | | $2,691.53 | $6,025.60 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,128.31 / $15,848.93
| Facility | | $4,570.88 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $407.38 / $660.69
| Professional | | $316.23 | $407.38 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $100.00 / $2,398.83
| Facility | | $58.88 | $100.00 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,413.10
| Professional | | $7,079.46 | $7,079.46 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $501.19 / $16,982.44
| Professional | | $398.11 | $501.19 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |