- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,265.80 / $19,498.45
| Facility | | $4,168.69 | $4,265.80 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $3,235.94
| Professional | | $1,949.84 | $2,630.27 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,079.46 / $14,791.08
| Facility | | $3,715.35 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $7,079.46
| Professional | | $3,388.44 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $11,481.54 / $25,703.96
| Facility | | $151.36 | $11,481.54 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,090.30 / $3,311.31
| Professional | | $2,570.40 | $3,090.30 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,235.94 / $6,606.93
| Facility | | $1,513.56 | $3,235.94 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,949.84 / $3,388.44
| Professional | | $1,288.25 | $1,949.84 | $3,388.44 |