- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $13,489.63 / $17,378.01
| Facility | | $2,454.71 | $13,489.63 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,888.44 / $10,715.19
| Professional | | $2,454.71 | $5,888.44 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,760.83 / $21,379.62
| Facility | | $6,606.93 | $6,760.83 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,128.31 / $16,595.87
| Professional | | $3,548.13 | $8,128.31 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $44.67 / $79.43
| Professional | | $25.12 | $44.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,332.54 / $36,307.81
| Facility | | $6,606.93 | $9,332.54 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,079.46 / $7,762.47
| Professional | | $6,606.93 | $7,079.46 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $24,547.09
| Professional | | $5,495.41 | $5,495.41 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,918.31 / $11,481.54
| Professional | | $6,165.95 | $6,918.31 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,677.35
| Professional | | $3,235.94 | $3,235.94 | $4,677.35 |