- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,370.32 / $9,772.37
| Facility | | $1,778.28 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $3,388.44
| Professional | | $1,778.28 | $1,778.28 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,801.89 / $4,466.84
| Facility | | $478.63 | $3,801.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $3,467.37 / $3,467.37
| Professional | | $239.88 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,762.47 / $10,715.19
| Facility | | $5,495.41 | $7,762.47 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,511.38 / $19,498.45
| Professional | | $1,737.80 | $8,511.38 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $8,128.31
| Professional | | $3,162.28 | $3,981.07 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,265.80 / $7,413.10
| Professional | | $3,467.37 | $4,265.80 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,467.37
| Facility | | $3,162.28 | $3,162.28 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $4,786.30
| Professional | | $1,479.11 | $2,089.30 | $4,786.30 |