- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $6,918.31
| Facility | | $3,162.28 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,370.32 / $10,715.19
| Professional | | $4,365.16 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,606.93 / $10,715.19
| Professional | | $1,445.44 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $10,964.78
| Professional | | $32.36 | $33.11 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,511.38 / $11,481.54
| Professional | | $6,309.57 | $8,511.38 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,912.51 / $11,481.54
| Professional | | $4,466.84 | $8,912.51 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,244.36 / $9,772.37
| Professional | | $6,025.60 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,495.41 / $9,120.11
| Professional | | $4,365.16 | $5,495.41 | $9,120.11 |