- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,495.41 / $7,762.47
| Facility | | $2,884.03 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,344.23 / $2,344.23
| Professional | | $1,148.15 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,760.83 / $14,791.08
| Facility | | $4,073.80 | $6,760.83 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,025.60 / $9,332.54
| Professional | | $5,370.32 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $7,762.47
| Facility | | $2,884.03 | $4,466.84 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,344.23 / $7,762.47
| Professional | | $1,148.15 | $2,344.23 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,882.50 / $18,197.01
| Facility | | $9,772.37 | $12,882.50 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,332.54 / $14,791.08
| Professional | | $6,025.60 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $22,387.21 / $27,542.29
| Facility | | $10,232.93 | $22,387.21 | $27,542.29 |