- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,370.32 / $10,715.19
| Facility | | $3,162.28 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $6,456.54
| Professional | | $3,388.44 | $4,168.69 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,197.01 / $33,113.11
| Facility | | $11,481.54 | $18,197.01 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,677.35 / $6,606.93
| Professional | | $3,715.35 | $4,677.35 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,248.07 / $6,918.31
| Professional | | $4,073.80 | $5,248.07 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $13,803.84 / $13,803.84
| Professional | | $4,466.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,388.44
| Professional | | $3,162.28 | $3,162.28 | $3,388.44 |
- 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
- $4,365.16 / $5,495.41 / $9,120.11
| Professional | | $4,365.16 | $5,495.41 | $9,120.11 |