- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,466.84 / $10,232.93
| Facility | | $2,238.72 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,890.45 / $6,456.54
| Professional | | $3,388.44 | $3,890.45 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $10,964.78
| Facility | | $5,370.32 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,677.35 / $7,943.28
| Professional | | $3,311.31 | $4,677.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,365.16 / $6,760.83
| Professional | | $2,691.53 | $4,365.16 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $3,388.44 / $5,011.87
| Professional | | $57.54 | $3,388.44 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $5,011.87
| Professional | | $48.98 | $48.98 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $7,585.78
| Professional | | $3,388.44 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,905.46 / $6,606.93
| Facility | | $776.25 | $1,905.46 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,365.16 / $6,918.31
| Professional | | $3,235.94 | $4,365.16 | $6,918.31 |