- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,918.45 / $4,430.46 / $14,263.20
| Facility | | $3,918.45 | $4,430.46 | $14,263.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,918.45 / $4,075.19 / $4,440.91
| Professional | | $3,918.45 | $4,075.19 | $4,440.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,716.79 / $6,896.47 / $10,292.45
| Professional | | $2,716.79 | $6,896.47 | $10,292.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,446.93 / $11,256.89 / $18,655.16
| Facility | | $3,446.93 | $11,256.89 | $18,655.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,224.60 / $5,224.60 / $25,182.57
| Professional | | $5,224.60 | $5,224.60 | $25,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,090.79 / $24,816.85 / $24,816.85
| Facility | | $9,090.79 | $24,816.85 | $24,816.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,018.51 / $26,018.51 / $39,184.50
| Professional | | $26,018.51 | $26,018.51 | $39,184.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $3,134.76 / $5,224.60
| Professional | | $2,194.33 | $3,134.76 | $5,224.60 |