- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,025.60 / $8,709.64
| Facility | | $2,290.87 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $8,709.64
| Professional | | $1,380.38 | $2,041.74 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,187.76 / $3,388.44
| Professional | | $1,445.44 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,019.95
| Professional | | $32.36 | $33.11 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,772.37 / $21,379.62
| Facility | | $8,317.64 | $9,772.37 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,090.30 / $4,073.80
| Professional | | $2,041.74 | $3,090.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,884.03 / $3,801.89
| Professional | | $1,412.54 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,344.23 / $3,630.78
| Professional | | $1,949.84 | $2,344.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $2,630.27
| Professional | | $1,318.26 | $1,659.59 | $2,630.27 |