- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,467.37 / $8,128.31
| Facility | | $2,511.89 | $3,467.37 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,819.70 / $2,137.96
| Professional | | $1,412.54 | $1,819.70 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $6,606.93
| Facility | | $2,187.76 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $1,071.52
| Professional | | $436.52 | $512.86 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $31,622.78 / $47,863.01
| Facility | | $2,137.96 | $31,622.78 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $8,511.38
| Facility | | $1,445.44 | $1,445.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,691.53 / $6,606.93
| Professional | | $676.08 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,187.76
| Professional | | $933.25 | $1,318.26 | $2,187.76 |