- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,888.44 / $7,413.10
| Facility | | $4,897.79 | $5,888.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,623.41 / $7,413.10
| Professional | | $3,981.07 | $5,623.41 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $17,378.01
| Facility | | $398.11 | $398.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,570.88 / $8,912.51
| Professional | | $3,090.30 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,456.54 / $7,585.78
| Facility | | $6,309.57 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,456.54 / $13,489.63
| Professional | | $3,548.13 | $6,456.54 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $954.99 / $4,786.30
| Facility | | $346.74 | $954.99 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,311.31 / $6,165.95
| Professional | | $2,238.72 | $3,311.31 | $6,165.95 |