- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $8,511.38 / $9,772.37
| Facility | | $2,398.83 | $8,511.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,238.72 / $6,606.93
| Professional | | $1,862.09 | $2,238.72 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $15,488.17 / $24,547.09
| Facility | | $5,623.41 | $15,488.17 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $6,165.95
| Professional | | $1,862.09 | $4,265.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $3,981.07 / $7,079.46
| Professional | | $630.96 | $3,981.07 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,388.44 / $5,754.40
| Professional | | $2,137.96 | $3,388.44 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,467.37 / $6,309.57
| Professional | | $2,137.96 | $3,467.37 | $6,309.57 |