- 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
- $1,202.26 / $1,412.54 / $6,025.60
| Professional | | $1,202.26 | $1,412.54 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $8,317.64
| Facility | | $1,174.90 | $1,584.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,715.35 / $8,317.64
| Professional | | $2,884.03 | $3,715.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $7,079.46
| Professional | | $5,128.61 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,025.60 / $8,511.38
| Facility | | $1,584.89 | $6,025.60 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,174.90 / $3,890.45
| Professional | | $60.26 | $1,174.90 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,162.28 / $7,585.78
| Professional | | $3,090.30 | $3,162.28 | $7,585.78 |