- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $12,022.64 / $16,595.87
| Facility | | $3,548.13 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $5,370.32
| Professional | | $1,071.52 | $1,445.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $7,413.10
| Facility | | $1,148.15 | $1,862.09 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,311.31 / $7,943.28
| Professional | | $2,570.40 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $7,079.46
| Professional | | $4,570.88 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $7,585.78
| Facility | | $1,862.09 | $5,370.32 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,096.48 / $3,981.07
| Professional | | $60.26 | $1,096.48 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,162.28 / $7,244.36
| Professional | | $2,884.03 | $3,162.28 | $7,244.36 |