- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,754.40 / $23,988.33
| Facility | | $3,890.45 | $5,754.40 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,890.45 / $6,025.60
| Professional | | $3,467.37 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $426.58
| Facility | | $218.78 | $323.59 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $13,803.84
| Facility | | $3,388.44 | $3,388.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $7,585.78
| Professional | | $6,309.57 | $6,309.57 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,248.07 / $9,120.11
| Facility | | $3,890.45 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $19,498.45
| Professional | | $2,187.76 | $2,187.76 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,248.07 / $6,309.57
| Facility | | $2,187.76 | $5,248.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $3,467.37
| Professional | | $2,187.76 | $2,187.76 | $3,467.37 |