- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $10,964.78 / $16,595.87
| Facility | | $2,884.03 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,122.02 / $5,248.07
| Professional | | $851.14 | $1,122.02 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Professional | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $7,413.10
| Facility | | $1,047.13 | $1,513.56 | $7,413.10 |
- 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
- $3,801.89 / $3,801.89 / $5,495.41
| Professional | | $3,801.89 | $3,801.89 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,248.07 / $7,585.78
| Facility | | $1,513.56 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $912.01 / $3,235.94
| Professional | | $60.26 | $912.01 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,630.27 / $6,918.31
| Professional | | $2,398.83 | $2,630.27 | $6,918.31 |