- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $12,022.64 / $16,595.87
| Facility | | $2,884.03 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,258.93 / $5,370.32
| Professional | | $977.24 | $1,258.93 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Professional | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,370.32 / $7,762.47
| Facility | | $1,348.96 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,754.23 / $6,606.93
| Professional | | $2,137.96 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,890.45 / $5,495.41
| Professional | | $3,630.78 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,370.32 / $7,762.47
| Facility | | $1,348.96 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $954.99 / $3,388.44
| Professional | | $60.26 | $954.99 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,691.53 / $6,165.95
| Professional | | $1,513.56 | $2,691.53 | $6,165.95 |