- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $10,471.29 / $15,135.61
| Facility | | $4,570.88 | $10,471.29 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,659.59 / $5,623.41
| Professional | | $1,258.93 | $1,659.59 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $17,378.01 / $19,952.62
| Facility | | $8,709.64 | $17,378.01 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,691.53 / $3,090.30
| Professional | | $1,318.26 | $2,691.53 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,238.72 / $3,630.78
| Professional | | $1,479.11 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $2,238.72
| Professional | | $1,995.26 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Professional | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $16,218.10
| Facility | | $3,311.31 | $6,165.95 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,187.76 / $4,265.80
| Professional | | $1,380.38 | $2,187.76 | $4,265.80 |