- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,370.32 / $9,549.93
| Facility | | $2,137.96 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $3,019.95
| Professional | | $1,479.11 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,025.60 / $12,302.69
| Facility | | $2,238.72 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $4,168.69
| Professional | | $1,479.11 | $2,630.27 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,951.21 / $58,884.37
| Facility | | $501.19 | $2,951.21 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,691.53 / $4,570.88
| Professional | | $1,737.80 | $2,691.53 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,570.40 / $9,332.54
| Professional | | $1,949.84 | $2,570.40 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Professional | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,235.94 / $7,943.28
| Facility | | $630.96 | $3,235.94 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,089.30 / $3,890.45
| Professional | | $1,412.54 | $2,089.30 | $3,890.45 |