- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $12,022.64 / $16,595.87
| Facility | | $5,623.41 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,454.71 / $10,471.29
| Professional | | $1,905.46 | $2,454.71 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Professional | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,754.23 / $14,454.40
| Facility | | $2,238.72 | $2,754.23 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,623.41 / $12,589.25
| Professional | | $4,365.16 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $7,585.78 / $10,471.29
| Professional | | $6,918.31 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $10,471.29 / $14,791.08
| Facility | | $2,754.23 | $10,471.29 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,819.70 / $6,309.57
| Professional | | $60.26 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,585.78 / $11,748.98
| Professional | | $2,511.89 | $7,585.78 | $11,748.98 |