- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,549.93 / $37,153.52
| Facility | | $3,890.45 | $9,549.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,265.80 / $5,011.87
| Professional | | $3,715.35 | $4,265.80 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,168.69 / $12,022.64
| Facility | | $2,238.72 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $3,019.95
| Professional | | $1,995.26 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $15,135.61
| Facility | | $3,235.94 | $5,888.44 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,025.60 / $7,244.36
| Professional | | $5,754.40 | $6,025.60 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $8,128.31
| Professional | | $5,011.87 | $5,011.87 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Professional | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $5,248.07
| Professional | | $2,089.30 | $2,089.30 | $5,248.07 |