- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $16,595.87
| Facility | | $9,772.37 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $9,120.11
| Professional | | $1,548.82 | $2,238.72 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Professional | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,120.11 / $12,882.50
| Facility | | $1,862.09 | $9,120.11 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,819.70 / $9,120.11
| Professional | | $60.26 | $1,819.70 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,760.83 / $9,120.11
| Professional | | $6,165.95 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,120.11 / $12,882.50
| Facility | | $1,862.09 | $9,120.11 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,548.82 / $5,370.32
| Professional | | $60.26 | $1,548.82 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $8,912.51
| Professional | | $2,344.23 | $3,890.45 | $8,912.51 |