- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,630.27 / $7,585.78
| Facility | | $891.25 | $2,630.27 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,454.71
| Professional | | $1,174.90 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,344.23 / $4,365.16
| Facility | | $1,023.29 | $2,344.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,905.46 / $2,951.21
| Professional | | $1,230.27 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $2,187.76
| Facility | | $501.19 | $524.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,621.81 / $2,818.38
| Professional | | $1,174.90 | $1,621.81 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $17,378.01
| Facility | | $4,466.84 | $4,466.84 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $10,964.78 / $10,964.78
| Professional | | $9,772.37 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,606.93 / $19,498.45
| Facility | | $1,737.80 | $6,606.93 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Professional | | $1,096.48 | $1,445.44 | $2,398.83 |