- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $10,964.78 / $16,595.87
| Facility | | $2,570.40 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,047.13 / $4,073.80
| Professional | | $933.25 | $1,047.13 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Professional | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $5,754.40
| Facility | | $954.99 | $1,258.93 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,511.89 / $5,888.44
| Professional | | $1,949.84 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $4,786.30
| Professional | | $3,548.13 | $3,548.13 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,073.80 / $5,888.44
| Facility | | $1,258.93 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $794.33 / $2,754.23
| Professional | | $60.26 | $794.33 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,238.72 / $4,897.79
| Professional | | $2,137.96 | $2,238.72 | $4,897.79 |