- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,772.37 / $18,197.01
| Facility | | $7,413.10 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,818.38 / $3,467.37
| Professional | | $2,754.23 | $2,818.38 | $3,467.37 |
- 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
- $5,248.07 / $5,754.40 / $6,025.60
| Professional | | $5,248.07 | $5,754.40 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,079.46 / $8,709.64
| Professional | | $4,365.16 | $7,079.46 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,398.83 / $17,378.01
| Facility | | $1,318.26 | $2,398.83 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $10,715.19
| Professional | | $1,548.82 | $2,187.76 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $4,365.16
| Professional | | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,467.37 / $7,413.10
| Facility | | $1,548.82 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,187.76 / $3,715.35
| Professional | | $2,089.30 | $2,187.76 | $3,715.35 |