- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $12,022.64 / $16,595.87
| Facility | | $2,511.89 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $3,981.07
| Professional | | $724.44 | $954.99 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Professional | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $5,623.41
| Facility | | $912.01 | $1,148.15 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,454.71 / $5,754.40
| Professional | | $1,905.46 | $2,454.71 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,235.94 / $4,786.30
| Professional | | $2,754.23 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $5,754.40
| Facility | | $1,122.02 | $3,981.07 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $812.83 / $2,818.38
| Professional | | $60.26 | $812.83 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,238.72 / $5,623.41
| Professional | | $2,187.76 | $2,238.72 | $5,623.41 |