- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,244.36 / $15,848.93
| Facility | | $3,981.07 | $7,244.36 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $1,548.82 / $3,019.95
| Professional | | $77.62 | $1,548.82 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,135.61 / $16,595.87
| Facility | | $8,317.64 | $15,135.61 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $1,778.28 / $4,786.30
| Professional | | $112.20 | $1,778.28 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $446.68 / $5,248.07
| Professional | | $93.33 | $446.68 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,715.35 / $4,570.88
| Professional | | $2,691.53 | $3,715.35 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,471.29 / $16,218.10
| Facility | | $6,456.54 | $10,471.29 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $354.81 / $4,168.69
| Professional | | $79.43 | $354.81 | $4,168.69 |