- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $12,589.25 / $23,442.29
| Facility | | $3,388.44 | $12,589.25 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,630.78 / $4,786.30
| Professional | | $3,162.28 | $3,630.78 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $2,951.21
| Facility | | $1,174.90 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $7,413.10 / $7,762.47
| Professional | | $6,918.31 | $7,413.10 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,120.11 / $11,481.54
| Professional | | $5,754.40 | $9,120.11 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,025.60 / $22,908.68
| Facility | | $2,884.03 | $6,025.60 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $13,803.84
| Professional | | $1,995.26 | $2,884.03 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Professional | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,570.88 / $9,549.93
| Facility | | $1,995.26 | $4,570.88 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,884.03 / $4,786.30
| Professional | | $2,754.23 | $2,884.03 | $4,786.30 |