- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $2,344.23 / $3,388.44
| Professional | | $158.49 | $2,344.23 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,964.78 / $18,197.01
| Facility | | $7,079.46 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $229.09 / $3,801.89
| Professional | | $165.96 | $229.09 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $2,754.23 / $4,168.69
| Professional | | $199.53 | $2,754.23 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $2,884.03 / $8,912.51
| Facility | | $165.96 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,630.78 / $19,952.62
| Professional | | $1,288.25 | $3,630.78 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $2,344.23 / $4,570.88
| Professional | | $165.96 | $2,344.23 | $4,570.88 |