- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $10,715.19
| Facility | | $2,754.23 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,698.24 / $3,467.37
| Professional | | $1,258.93 | $1,698.24 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $11,481.54 / $23,988.33
| Facility | | $6,025.60 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,089.30 / $2,884.03
| Professional | | $1,621.81 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,041.74 / $2,818.38
| Professional | | $1,348.96 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,995.26 / $4,265.80
| Professional | | $1,949.84 | $1,995.26 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,479.11
| Professional | | $1,380.38 | $1,380.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,022.64 / $20,417.38
| Facility | | $8,511.38 | $12,022.64 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,905.46 / $3,388.44
| Professional | | $1,380.38 | $1,905.46 | $3,388.44 |