- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $9,332.54
| Facility | | $7,585.78 | $7,585.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,079.46 / $10,715.19
| Professional | | $5,370.32 | $7,079.46 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $6,165.95
| Facility | | $5,128.61 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $14,791.08 / $18,620.87
| Professional | | $954.99 | $14,791.08 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $10,715.19
| Professional | | $1,230.27 | $1,230.27 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $8,511.38 / $19,952.62
| Facility | | $630.96 | $8,511.38 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,265.80 / $11,748.98
| Professional | | $3,311.31 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,318.26 / $5,623.41
| Facility | | $380.19 | $1,318.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,265.80 / $11,748.98
| Professional | | $3,548.13 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,481.54 / $11,481.54
| Professional | | $9,120.11 | $11,481.54 | $11,481.54 |