- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,022.64 / $16,595.87
| Facility | | $4,897.79 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,949.84 / $4,897.79
| Professional | | $1,445.44 | $1,949.84 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,238.72 / $5,495.41
| Professional | | $1,584.89 | $2,238.72 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $6,309.57
| Facility | | $1,621.81 | $2,344.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,128.61 / $9,772.37
| Professional | | $3,467.37 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,606.93 / $9,549.93
| Professional | | $3,981.07 | $6,606.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,398.83 / $6,309.57
| Facility | | $1,737.80 | $2,398.83 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $2,344.23 / $5,495.41
| Professional | | $60.26 | $2,344.23 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $10,471.29
| Professional | | $1,548.82 | $4,365.16 | $10,471.29 |