- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,897.79 / $10,471.29
| Facility | | $4,570.88 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,090.30 / $5,623.41
| Professional | | $2,398.83 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $17,378.01 / $36,307.81
| Facility | | $9,120.11 | $17,378.01 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,370.32 / $6,025.60
| Professional | | $2,454.71 | $5,370.32 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,265.80 / $6,918.31
| Professional | | $2,818.38 | $4,265.80 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $4,677.35
| Professional | | $3,890.45 | $3,890.45 | $4,677.35 |
- 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
- $2,630.27 / $4,073.80 / $8,128.31
| Professional | | $2,630.27 | $4,073.80 | $8,128.31 |