- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,897.79 / $6,760.83
| Facility | | $3,388.44 | $4,897.79 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,011.87 / $5,370.32
| Professional | | $3,311.31 | $5,011.87 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,388.44 / $3,467.37
| Facility | | $3,235.94 | $3,388.44 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,489.63 / $16,595.87
| Professional | | $13,182.57 | $13,489.63 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $436.52 / $758.58
| Professional | | $151.36 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $14,454.40 / $33,884.42
| Facility | | $2,818.38 | $14,454.40 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,137.96 / $9,120.11
| Professional | | $1,096.48 | $2,137.96 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,025.60 / $8,709.64
| Professional | | $2,570.40 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $15,135.61 / $30,199.52
| Facility | | $9,549.93 | $15,135.61 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,737.80 / $3,548.13
| Professional | | $1,122.02 | $1,737.80 | $3,548.13 |