- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,691.53 / $7,585.78
| Facility | | $2,398.83 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,467.37 / $5,754.40
| Professional | | $2,818.38 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,344.23 / $4,897.79
| Facility | | $1,258.93 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,466.84 / $7,079.46
| Professional | | $3,311.31 | $4,466.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,890.45 / $6,456.54
| Professional | | $2,951.21 | $3,890.45 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $42,657.95 / $42,657.95
| Facility | | $54.95 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,387.21 / $28,840.32 / $28,840.32
| Professional | | $22,387.21 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,630.27 / $4,786.30
| Facility | | $1,258.93 | $2,630.27 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,073.80 / $6,606.93
| Professional | | $2,884.03 | $4,073.80 | $6,606.93 |