- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,466.84 / $10,232.93
| Facility | | $1,479.11 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,380.38 / $2,398.83
| Professional | | $1,202.26 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,128.31 / $11,748.98
| Facility | | $4,677.35 | $8,128.31 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $2,691.53
| Professional | | $1,174.90 | $1,584.89 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,548.82 / $2,454.71
| Professional | | $851.14 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $1,288.25 / $1,905.46
| Professional | | $16.22 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $1,862.09
| Professional | | $13.80 | $13.80 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $2,511.89
| Professional | | $1,230.27 | $1,230.27 | $2,511.89 |
- 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
- $1,148.15 / $1,479.11 / $2,398.83
| Professional | | $1,148.15 | $1,479.11 | $2,398.83 |