- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,691.53 / $7,585.78
| Facility | | $2,398.83 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,623.41 / $8,128.31
| Professional | | $5,248.07 | $5,623.41 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,344.23 / $4,897.79
| Facility | | $1,258.93 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,511.38 / $13,803.84
| Professional | | $6,165.95 | $8,511.38 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,943.28 / $12,302.69
| Professional | | $5,888.44 | $7,943.28 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $51,286.14 / $51,286.14
| Facility | | $54.95 | $51,286.14 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39,810.72 / $48,977.88 / $48,977.88
| Professional | | $39,810.72 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,630.27 / $4,786.30
| Facility | | $1,258.93 | $2,630.27 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,762.47 / $12,022.64
| Professional | | $5,623.41 | $7,762.47 | $12,022.64 |