- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $12,022.64 / $16,595.87
| Facility | | $3,388.44 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,445.44 / $6,309.57
| Professional | | $1,122.02 | $1,445.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $8,912.51
| Facility | | $1,318.26 | $1,659.59 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,311.31 / $7,762.47
| Professional | | $2,570.40 | $3,311.31 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,466.84 / $6,456.54
| Professional | | $4,168.69 | $4,466.84 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,309.57 / $9,120.11
| Facility | | $1,659.59 | $6,309.57 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,096.48 / $3,890.45
| Professional | | $60.26 | $1,096.48 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,677.35 / $7,244.36
| Professional | | $1,659.59 | $4,677.35 | $7,244.36 |