- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,981.07 / $14,791.08
| Facility | | $2,398.83 | $3,981.07 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $3,162.28
| Professional | | $912.01 | $1,288.25 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,623.41 / $8,912.51
| Facility | | $5,011.87 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,238.72 / $3,162.28
| Professional | | $1,047.13 | $2,238.72 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $2,238.72 / $3,548.13
| Professional | | $389.05 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,949.84 / $3,311.31
| Professional | | $1,202.26 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,995.26 / $3,890.45
| Professional | | $1,258.93 | $1,995.26 | $3,890.45 |