- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,370.32 / $10,715.19
| Facility | | $3,090.30 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,467.37 / $7,585.78
| Professional | | $2,691.53 | $3,467.37 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $25,703.96 / $56,234.13
| Facility | | $15,848.93 | $25,703.96 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $5,248.07
| Professional | | $2,951.21 | $3,715.35 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $5,495.41
| Professional | | $3,090.30 | $4,073.80 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $15,848.93 / $15,848.93
| Professional | | $3,630.78 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,691.53
| Professional | | $2,570.40 | $2,570.40 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $12,882.50
| Facility | | $2,630.27 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,168.69 / $7,079.46
| Professional | | $3,162.28 | $4,168.69 | $7,079.46 |