- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,466.84 / $10,232.93
| Facility | | $2,238.72 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $5,248.07
| Professional | | $2,041.74 | $2,398.83 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $14,454.40
| Facility | | $7,413.10 | $12,022.64 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $4,570.88
| Professional | | $2,398.83 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $3,890.45
| Professional | | $1,949.84 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $2,454.71 / $3,630.78
| Professional | | $29.51 | $2,454.71 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $25.70 / $3,235.94
| Professional | | $25.70 | $25.70 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,187.76
| Professional | | $2,137.96 | $2,137.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,570.40 / $6,606.93
| Facility | | $1,071.52 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,691.53 / $4,073.80
| Professional | | $2,137.96 | $2,691.53 | $4,073.80 |