- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,786.30 / $10,471.29
| Facility | | $1,659.59 | $4,786.30 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,348.96 / $3,235.94
| Professional | | $1,202.26 | $1,348.96 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,949.84 / $3,235.94
| Professional | | $1,479.11 | $1,949.84 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,162.28
| Professional | | $1,318.26 | $1,905.46 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,698.24 / $2,691.53
| Facility | | $1,288.25 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $2,041.74 / $3,311.31
| Professional | | $6.03 | $2,041.74 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $2,951.21
| Professional | | $1,174.90 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $10,471.29 / $10,471.29
| Facility | | $56.23 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Professional | | $11,481.54 | $11,481.54 | $11,481.54 |