- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $14,791.08 / $23,442.29
| Facility | | $8,128.31 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $6,309.57
| Professional | | $1,548.82 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $9,120.11
| Facility | | $1,905.46 | $1,905.46 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $6,165.95
| Professional | | $1,905.46 | $1,905.46 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,079.46 / $7,585.78
| Facility | | $1,905.46 | $7,079.46 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,248.07 / $9,120.11
| Facility | | $1,513.56 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,801.89 / $5,754.40
| Professional | | $1,148.15 | $3,801.89 | $5,754.40 |