- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $10,232.93
| Facility | | $2,238.72 | $4,677.35 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,677.35 / $12,302.69
| Professional | | $2,754.23 | $4,677.35 | $12,302.69 |
- 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
- $2,344.23 / $5,248.07 / $7,244.36
| Professional | | $2,344.23 | $5,248.07 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,162.28 / $6,918.31
| Professional | | $1,412.54 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $4,466.84 / $6,606.93
| Professional | | $27.54 | $4,466.84 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $5,623.41
| Professional | | $23.44 | $23.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Professional | | $3,715.35 | $3,715.35 | $3,715.35 |
- 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
- $1,737.80 / $4,265.80 / $7,079.46
| Professional | | $1,737.80 | $4,265.80 | $7,079.46 |