- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $9,549.93 / $17,782.79
| Facility | | $2,570.40 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,754.23 / $3,630.78
| Professional | | $2,398.83 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $2,951.21
| Facility | | $1,174.90 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,623.41 / $5,888.44
| Professional | | $5,248.07 | $5,623.41 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,918.31 / $8,709.64
| Professional | | $4,365.16 | $6,918.31 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $16,982.44
| Facility | | $2,137.96 | $4,466.84 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $10,471.29
| Professional | | $1,513.56 | $2,137.96 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $4,365.16
| Professional | | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,388.44 / $7,244.36
| Facility | | $1,513.56 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,137.96 / $3,630.78
| Professional | | $2,041.74 | $2,137.96 | $3,630.78 |