- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $12,022.64 / $16,595.87
| Facility | | $5,128.61 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $9,549.93
| Professional | | $1,737.80 | $2,238.72 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Professional | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,511.89 / $13,182.57
| Facility | | $2,041.74 | $2,511.89 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,128.61 / $11,481.54
| Professional | | $3,981.07 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,760.83 / $9,549.93
| Professional | | $6,309.57 | $6,760.83 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $9,549.93 / $13,489.63
| Facility | | $2,511.89 | $9,549.93 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,659.59 / $5,754.40
| Professional | | $60.26 | $1,659.59 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,677.35 / $10,715.19
| Professional | | $2,344.23 | $4,677.35 | $10,715.19 |