- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,025.60 / $10,964.78
| Facility | | $3,981.07 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,238.72 / $6,456.54
| Professional | | $1,778.28 | $2,238.72 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,135.61 / $16,595.87
| Facility | | $8,317.64 | $15,135.61 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,981.07 / $5,623.41
| Professional | | $1,995.26 | $3,981.07 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $5,754.40
| Professional | | $2,454.71 | $3,715.35 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,951.21 / $3,801.89
| Professional | | $1,905.46 | $2,951.21 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $10,232.93 / $16,218.10
| Facility | | $4,677.35 | $10,232.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,090.30 / $5,623.41
| Professional | | $1,905.46 | $3,090.30 | $5,623.41 |