- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,623.41 / $9,549.93
| Facility | | $3,715.35 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $4,677.35 / $10,964.78
| Professional | | $478.63 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $645.65 / $11,220.18
| Professional | | $616.60 | $645.65 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,370.32 / $11,220.18
| Facility | | $2,187.76 | $5,370.32 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $1,412.54
| Professional | | $588.84 | $891.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,511.89 / $4,786.30
| Facility | | $870.96 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,479.11 / $12,589.25
| Professional | | $645.65 | $1,479.11 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $5,888.44 / $31,622.78
| Professional | | $512.86 | $5,888.44 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,413.10 / $15,135.61
| Facility | | $1,995.26 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $5,370.32 / $12,882.50
| Professional | | $537.03 | $5,370.32 | $12,882.50 |