- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,370.32 / $10,715.19
| Facility | | $3,090.30 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,819.70 / $3,801.89
| Professional | | $1,412.54 | $1,819.70 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $20,417.38 / $38,904.51
| Facility | | $14,125.38 | $20,417.38 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,290.87 / $3,090.30
| Professional | | $1,778.28 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,398.83 / $3,235.94
| Professional | | $1,584.89 | $2,398.83 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $12,302.69
| Professional | | $2,187.76 | $2,187.76 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,621.81
| Professional | | $1,548.82 | $1,548.82 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $12,882.50
| Facility | | $2,630.27 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,238.72 / $3,981.07
| Professional | | $1,698.24 | $2,238.72 | $3,981.07 |