- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,585.78 / $11,220.18
| Facility | | $3,801.89 | $7,585.78 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,584.89 / $3,235.94
| Professional | | $446.68 | $1,584.89 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $19,952.62
| Facility | | $8,709.64 | $16,982.44 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,905.46 / $5,248.07
| Professional | | $794.33 | $1,905.46 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,412.54 / $5,011.87
| Professional | | $691.83 | $1,412.54 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,073.80
| Professional | | $3,311.31 | $3,311.31 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $18,620.87
| Facility | | $7,244.36 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,778.28 / $5,011.87
| Professional | | $512.86 | $1,778.28 | $5,011.87 |