- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,890.45 / $7,943.28
| Facility | | $2,041.74 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,370.32 / $11,748.98
| Professional | | $4,466.84 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,365.16 / $7,943.28
| Facility | | $1,659.59 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,309.57 / $10,232.93
| Professional | | $4,897.79 | $6,309.57 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $10,232.93
| Professional | | $3,630.78 | $5,495.41 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,011.87 / $9,332.54
| Facility | | $2,137.96 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,165.95 / $35,481.34
| Professional | | $4,265.80 | $6,165.95 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,137.96 / $5,248.07
| Facility | | $831.76 | $2,137.96 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,248.07 / $9,120.11
| Professional | | $4,073.80 | $5,248.07 | $9,120.11 |