- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $14,454.40
| Facility | | $1,380.38 | $4,897.79 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,089.30 / $2,511.89
| Professional | | $1,380.38 | $2,089.30 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $30,902.95 / $43,651.58
| Facility | | $12,589.25 | $30,902.95 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,187.76 / $2,238.72
| Professional | | $1,949.84 | $2,187.76 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,801.89 / $52,480.75
| Facility | | $2,089.30 | $3,801.89 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.32 / $10,964.78
| Professional | | $1.12 | $1.32 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,623.41 / $12,022.64
| Facility | | $1,412.54 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,630.27 / $4,466.84
| Professional | | $1,862.09 | $2,630.27 | $4,466.84 |