- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,511.38 / $12,022.64
| Facility | | $6,456.54 | $8,511.38 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,912.51 / $12,302.69
| Professional | | $5,754.40 | $8,912.51 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,096.48 / $2,691.53
| Facility | | $851.14 | $1,096.48 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,606.93 / $14,791.08
| Professional | | $5,888.44 | $6,606.93 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $16,218.10 / $54,954.09
| Facility | | $3,019.95 | $16,218.10 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $22,387.21
| Professional | | $10,715.19 | $10,715.19 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,570.88 / $8,709.64
| Facility | | $549.54 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,760.83 / $10,715.19
| Professional | | $4,677.35 | $6,760.83 | $10,715.19 |