- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,466.84 / $10,232.93
| Facility | | $2,187.76 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,089.30 / $3,467.37
| Professional | | $1,778.28 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,025.60 / $7,762.47
| Facility | | $4,466.84 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $3,981.07
| Professional | | $1,737.80 | $2,344.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $3,630.78
| Professional | | $1,258.93 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $1,905.46 / $2,818.38
| Professional | | $26.92 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $2,691.53
| Professional | | $22.91 | $22.91 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $3,715.35
| Professional | | $1,819.70 | $1,819.70 | $3,715.35 |
- 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
- $1,659.59 / $2,137.96 / $3,548.13
| Professional | | $1,659.59 | $2,137.96 | $3,548.13 |