- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,641.41 / $3,641.41 / $9,726.66
| Facility | | $3,641.41 | $3,641.41 | $9,726.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,641.41 / $4,654.43 / $5,256.77
| Professional | | $3,641.41 | $4,654.43 | $5,256.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.56 / $5,475.80 / $7,021.85
| Facility | | $3,335.56 | $5,475.80 | $7,021.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.85 / $1,964.40 / $6,768.09
| Professional | | $1,702.85 | $1,964.40 | $6,768.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,475.80 / $7,939.91 / $11,769.10
| Facility | | $5,475.80 | $7,939.91 | $11,769.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,180.63 / $12,046.76 / $16,884.74
| Facility | | $8,180.63 | $12,046.76 | $16,884.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,928.22 / $6,023.38 / $7,666.12
| Professional | | $4,928.22 | $6,023.38 | $7,666.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,351.93 / $7,337.57 / $10,130.23
| Professional | | $6,351.93 | $7,337.57 | $10,130.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.84 / $3,285.48 / $9,585.39
| Professional | | $2,299.84 | $3,285.48 | $9,585.39 |