- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,964.78 / $16,595.87
| Facility | | $3,890.45 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,089.30 / $4,897.79
| Professional | | $1,513.56 | $2,089.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,495.41 / $7,079.46
| Professional | | $4,073.80 | $5,495.41 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,388.44 / $11,481.54
| Facility | | $1,445.44 | $3,388.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,897.79 / $8,511.38
| Professional | | $3,548.13 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,760.83 / $9,772.37
| Professional | | $5,370.32 | $6,760.83 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,691.53 / $8,912.51
| Facility | | $1,548.82 | $2,691.53 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $2,290.87 / $5,495.41
| Professional | | $60.26 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,585.78 / $9,772.37
| Professional | | $1,819.70 | $7,585.78 | $9,772.37 |