- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,181.10 / $10,900.00 / $14,552.94
| Facility | | $7,181.10 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.19 / $2,719.35 / $13,128.44
| Professional | | $2,215.19 | $2,719.35 | $13,128.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,418.26 / $3,734.83 / $8,313.89
| Professional | | $2,418.26 | $3,734.83 | $8,313.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.13 / $13,128.44 / $18,379.82
| Facility | | $2,498.13 | $13,128.44 | $18,379.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,119.95 / $9,086.40 / $16,761.53
| Professional | | $6,119.95 | $9,086.40 | $16,761.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,405.49 / $11,492.25 / $18,674.04
| Professional | | $6,405.49 | $11,492.25 | $18,674.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.13 / $13,128.44 / $18,379.82
| Facility | | $2,498.13 | $13,128.44 | $18,379.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,974.18 / $8,978.40 / $16,055.25
| Professional | | $2,974.18 | $8,978.40 | $16,055.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,737.85 / $6,651.12 / $18,346.05
| Professional | | $5,737.85 | $6,651.12 | $18,346.05 |