- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,466.84 / $8,511.38
| Facility | | $2,290.87 | $4,466.84 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,165.95 / $11,481.54
| Professional | | $3,890.45 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $2,344.23 / $12,589.25
| Professional | | $549.54 | $2,344.23 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Professional | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Professional | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,025.60 / $32,359.37
| Facility | | $2,951.21 | $6,025.60 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,488.17 / $47,863.01
| Professional | | $9,772.37 | $15,488.17 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $15,135.61
| Facility | | $3,162.28 | $4,786.30 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,454.40 / $25,703.96
| Professional | | $9,772.37 | $14,454.40 | $25,703.96 |