- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $14,125.38
| Facility | | $1,380.38 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,884.03 / $4,570.88
| Professional | | $2,570.40 | $2,884.03 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $30,199.52 / $43,651.58
| Facility | | $12,589.25 | $30,199.52 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,630.27 / $4,365.16
| Professional | | $2,344.23 | $2,630.27 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,818.38 / $3,162.28
| Facility | | $2,570.40 | $2,818.38 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,466.84 / $6,309.57
| Facility | | $2,951.21 | $4,466.84 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,388.44 / $5,754.40
| Professional | | $2,691.53 | $3,388.44 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,549.93 / $16,218.10
| Facility | | $1,862.09 | $9,549.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,162.28 / $5,370.32
| Professional | | $2,344.23 | $3,162.28 | $5,370.32 |