- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,079.46 / $14,454.40
| Facility | | $3,235.94 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,445.44 / $2,951.21
| Professional | | $1,047.13 | $1,445.44 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,197.01 / $33,113.11
| Facility | | $11,481.54 | $18,197.01 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $2,754.23
| Professional | | $1,445.44 | $1,905.46 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $12,589.25
| Facility | | $5,370.32 | $9,332.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Professional | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $1,202.26 / $1,698.24
| Professional | | $213.80 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $13,803.84 / $23,988.33
| Facility | | $10,471.29 | $13,803.84 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,137.96 / $3,467.37
| Professional | | $1,621.81 | $2,137.96 | $3,467.37 |