- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,079.46 / $13,489.63
| Facility | | $5,370.32 | $7,079.46 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,041.74 / $2,570.40
| Professional | | $1,778.28 | $2,041.74 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $575.44
| Facility | | $223.87 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,265.80 / $4,466.84
| Professional | | $3,890.45 | $4,265.80 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $6,456.54
| Professional | | $3,235.94 | $5,248.07 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,778.28 / $12,882.50
| Facility | | $977.24 | $1,778.28 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $7,762.47
| Professional | | $1,148.15 | $1,621.81 | $7,762.47 |
- 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
- $1,148.15 / $2,570.40 / $5,370.32
| Facility | | $1,148.15 | $2,570.40 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,621.81 / $2,691.53
| Professional | | $1,548.82 | $1,621.81 | $2,691.53 |