- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,370.32 / $16,218.10
| Facility | | $3,548.13 | $5,370.32 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,548.13 / $5,623.41
| Professional | | $3,019.95 | $3,548.13 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,413.10 / $15,488.17
| Facility | | $7,079.46 | $7,413.10 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $28,840.32
| Professional | | $2,951.21 | $4,677.35 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,235.94 / $24,547.09
| Facility | | $2,089.30 | $3,235.94 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,244.36 / $13,803.84
| Professional | | $1,202.26 | $7,244.36 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,244.36 / $26,915.35
| Facility | | $3,019.95 | $7,244.36 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,090.30 / $5,623.41
| Professional | | $2,398.83 | $3,090.30 | $5,623.41 |