- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $12,022.64 / $16,595.87
| Facility | | $2,951.21 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,258.93 / $5,495.41
| Professional | | $977.24 | $1,258.93 | $5,495.41 |
- 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
- $1,148.15 / $1,445.44 / $7,585.78
| Facility | | $1,148.15 | $1,445.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,884.03 / $6,606.93
| Professional | | $2,238.72 | $2,884.03 | $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
- $1,445.44 / $5,495.41 / $7,762.47
| Facility | | $1,445.44 | $5,495.41 | $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
- $1,412.54 / $3,981.07 / $6,165.95
| Professional | | $1,412.54 | $3,981.07 | $6,165.95 |