- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,405.77 / $3,795.24 / $15,955.88
| Facility | | $2,405.77 | $3,795.24 | $15,955.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.81 / $2,016.89 / $14,301.59
| Professional | | $464.81 | $2,016.89 | $14,301.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.94 / $502.62 / $634.91
| Professional | | $499.94 | $502.62 | $634.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,507.40 / $12,507.40 / $12,507.40
| Facility | | $12,507.40 | $12,507.40 | $12,507.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.23 / $1,185.02 / $13,888.08
| Professional | | $474.23 | $1,185.02 | $13,888.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,222.68 / $8,983.03 / $16,631.77
| Professional | | $5,222.68 | $8,983.03 | $16,631.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,985.42 / $8,811.44 / $15,458.81
| Professional | | $6,985.42 | $8,811.44 | $15,458.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,448.75 / $6,448.75 / $9,849.75
| Professional | | $6,448.75 | $6,448.75 | $9,849.75 |