- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,025.60 / $9,332.54
| Facility | | $1,995.26 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,621.81 / $7,244.36
| Professional | | $1,174.90 | $1,621.81 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $3,801.89
| Professional | | $1,258.93 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,801.89
| Professional | | $32.36 | $33.11 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $12,302.69 / $28,183.83
| Facility | | $10,471.29 | $12,302.69 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,754.23 / $5,623.41
| Professional | | $2,137.96 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,951.21 / $4,265.80
| Professional | | $1,258.93 | $2,951.21 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,137.96 / $3,388.44
| Professional | | $1,778.28 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,128.61 / $15,848.93
| Facility | | $3,019.95 | $5,128.61 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $2,344.23
| Professional | | $1,174.90 | $1,479.11 | $2,344.23 |