- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $14,454.40 / $26,915.35
| Facility | | $10,964.78 | $14,454.40 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,168.69 / $5,495.41
| Professional | | $4,073.80 | $4,168.69 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $575.44
| Facility | | $223.87 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $8,511.38 / $8,912.51
| Professional | | $7,943.28 | $8,511.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,471.29 / $13,182.57
| Professional | | $6,606.93 | $10,471.29 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $26,302.68
| Facility | | $1,949.84 | $3,630.78 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $15,848.93
| Professional | | $2,290.87 | $3,311.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Professional | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,248.07 / $10,964.78
| Facility | | $2,290.87 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,311.31 / $5,495.41
| Professional | | $3,090.30 | $3,311.31 | $5,495.41 |