- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,125.38 / $22,387.21
| Facility | | $2,344.23 | $14,125.38 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,659.59 / $4,073.80
| Professional | | $1,230.27 | $1,659.59 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $4,570.88
| Professional | | $1,318.26 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,995.26 / $5,370.32
| Facility | | $1,380.38 | $1,995.26 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,265.80 / $8,128.31
| Professional | | $2,951.21 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,623.41 / $7,943.28
| Professional | | $3,388.44 | $5,623.41 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,041.74 / $5,370.32
| Facility | | $1,479.11 | $2,041.74 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,995.26 / $4,570.88
| Professional | | $60.26 | $1,995.26 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,715.35 / $8,912.51
| Professional | | $1,288.25 | $3,715.35 | $8,912.51 |