- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,495.41 / $10,964.78
| Facility | | $1,230.27 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,951.21 / $5,248.07
| Professional | | $2,454.71 | $2,951.21 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,481.54 / $13,803.84
| Professional | | $9,549.93 | $11,481.54 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $21,379.62 / $33,113.11
| Facility | | $9,332.54 | $21,379.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,187.76 / $2,951.21
| Professional | | $2,089.30 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $4,073.80
| Professional | | $32.36 | $33.11 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,128.61 / $10,715.19
| Facility | | $676.08 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,388.44 / $6,165.95
| Professional | | $2,290.87 | $3,388.44 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,951.21
| Professional | | $2,238.72 | $2,238.72 | $2,951.21 |