- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,011.87 / $10,232.93
| Facility | | $2,238.72 | $5,011.87 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,888.44 / $7,413.10
| Professional | | $5,011.87 | $5,888.44 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $12,882.50
| Facility | | $5,370.32 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,762.47 / $11,481.54
| Professional | | $5,623.41 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,606.93 / $9,772.37
| Professional | | $2,137.96 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $6,025.60 / $8,709.64
| Professional | | $15.49 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $13.18 / $7,762.47
| Professional | | $13.18 | $13.18 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,370.32
| Professional | | $5,248.07 | $5,248.07 | $5,370.32 |
- 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
- $5,011.87 / $6,606.93 / $10,232.93
| Professional | | $5,011.87 | $6,606.93 | $10,232.93 |