- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,365.16 / $10,232.93
| Facility | | $3,890.45 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,265.80 / $10,232.93
| Professional | | $3,235.94 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,332.54 / $13,489.63
| Facility | | $6,165.95 | $9,332.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,677.35 / $6,760.83
| Professional | | $3,630.78 | $4,677.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $5,754.40
| Professional | | $2,691.53 | $3,630.78 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $3,890.45 / $5,495.41
| Professional | | $41.69 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $4,677.35
| Professional | | $36.31 | $36.31 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,570.40 / $6,606.93
| Facility | | $1,071.52 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,677.35 / $6,165.95
| Professional | | $3,090.30 | $4,677.35 | $6,165.95 |