- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $10,232.93 / $19,054.61
| Facility | | $2,754.23 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,951.21 / $3,890.45
| Professional | | $2,570.40 | $2,951.21 | $3,890.45 |
- 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
- $5,623.41 / $6,025.60 / $6,309.57
| Professional | | $5,623.41 | $6,025.60 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,413.10 / $9,332.54
| Professional | | $4,677.35 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,897.79 / $18,197.01
| Facility | | $2,344.23 | $4,897.79 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $11,220.18
| Professional | | $1,621.81 | $2,344.23 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,715.35 / $7,762.47
| Facility | | $1,621.81 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,344.23 / $3,890.45
| Professional | | $2,187.76 | $2,344.23 | $3,890.45 |