- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,754.23 / $14,454.40
| Facility | | $1,096.48 | $2,754.23 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $2,754.23
| Professional | | $977.24 | $1,230.27 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,905.46 / $2,951.21
| Professional | | $1,288.25 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $2,754.23
| Professional | | $1,230.27 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,290.87
| Facility | | $1,096.48 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $2,089.30 / $2,818.38
| Professional | | $6.03 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $15,135.61 / $22,908.68
| Facility | | $6,760.83 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $2,570.40
| Professional | | $1,047.13 | $1,479.11 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $27,542.29 / $27,542.29
| Facility | | $12,589.25 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $9,332.54
| Professional | | $8,912.51 | $8,912.51 | $9,332.54 |