- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,309.57 / $17,378.01
| Facility | | $3,548.13 | $6,309.57 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,041.74 / $3,801.89
| Professional | | $1,698.24 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,897.79 / $14,454.40
| Facility | | $4,265.80 | $4,897.79 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,621.81 / $2,344.23
| Professional | | $1,230.27 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $8,128.31 / $10,964.78
| Facility | | $4,073.80 | $8,128.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,630.27 / $10,471.29
| Professional | | $1,288.25 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $4,786.30
| Professional | | $2,511.89 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,862.09 / $6,309.57
| Professional | | $1,513.56 | $1,862.09 | $6,309.57 |