- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $12,022.64 / $16,595.87
| Facility | | $4,786.30 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,089.30 / $7,762.47
| Professional | | $1,548.82 | $2,089.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Professional | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $10,715.19
| Facility | | $1,862.09 | $2,511.89 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,370.32 / $10,964.78
| Professional | | $4,168.69 | $5,370.32 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $9,772.37
| Professional | | $6,918.31 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,762.47 / $10,964.78
| Facility | | $2,398.83 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,621.81 / $5,370.32
| Professional | | $60.26 | $1,621.81 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,265.80 / $9,772.37
| Professional | | $2,290.87 | $4,265.80 | $9,772.37 |