- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,918.31 / $10,471.29
| Facility | | $4,570.88 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,897.79 / $7,585.78
| Professional | | $1,737.80 | $4,897.79 | $7,585.78 |
- 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
- $4,073.80 / $8,912.51 / $10,232.93
| Professional | | $4,073.80 | $8,912.51 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,570.88 / $11,220.18
| Professional | | $2,137.96 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $7,762.47
| Professional | | $2,691.53 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,623.41 / $13,489.63
| Professional | | $2,344.23 | $5,623.41 | $13,489.63 |