- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,128.61 / $11,748.98
| Facility | | $1,905.46 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $4,365.16
| Professional | | $2,454.71 | $3,715.35 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,370.32 / $18,620.87
| Facility | | $2,570.40 | $5,370.32 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $2,570.40
| Professional | | $1,174.90 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $6,606.93 / $17,378.01
| Facility | | $562.34 | $6,606.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Professional | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $22,908.68 / $54,954.09
| Facility | | $13,182.57 | $22,908.68 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,265.80 / $7,079.46
| Professional | | $3,311.31 | $4,265.80 | $7,079.46 |