- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $10,471.29
| Facility | | $4,570.88 | $7,079.46 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,981.07 / $7,244.36
| Professional | | $3,388.44 | $3,981.07 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,630.78 / $8,511.38
| Facility | | $1,071.52 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,244.36 / $9,120.11
| Professional | | $3,801.89 | $7,244.36 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $9,772.37
| Facility | | $398.11 | $758.58 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,495.41 / $8,709.64
| Professional | | $2,951.21 | $5,495.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,677.35 / $10,964.78
| Professional | | $3,630.78 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $5,888.44 / $9,120.11
| Professional | | $15.14 | $5,888.44 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,511.89 / $7,079.46
| Facility | | $398.11 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,897.79 / $8,317.64
| Professional | | $3,548.13 | $4,897.79 | $8,317.64 |