- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $9,549.93 / $26,302.68
| Facility | | $5,248.07 | $9,549.93 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,630.27 / $3,630.78
| Professional | | $1,584.89 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,244.36 / $21,379.62
| Facility | | $6,456.54 | $7,244.36 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,454.71 / $3,548.13
| Professional | | $1,513.56 | $2,454.71 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $13,803.84 / $16,595.87
| Facility | | $6,025.60 | $13,803.84 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,981.07 / $15,488.17
| Professional | | $1,949.84 | $3,981.07 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $7,079.46
| Professional | | $3,715.35 | $3,715.35 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $5,754.40
| Professional | | $1,737.80 | $2,238.72 | $5,754.40 |