- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,311.31 / $7,762.47
| Facility | | $2,454.71 | $3,311.31 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $2,041.74
| Professional | | $1,380.38 | $1,737.80 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $6,309.57
| Facility | | $2,137.96 | $2,137.96 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $13.18 / $28.18
| Professional | | $11.22 | $13.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $30,902.95 / $46,773.51
| Facility | | $2,041.74 | $30,902.95 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $8,317.64
| Facility | | $1,380.38 | $1,380.38 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $2,570.40 / $6,456.54
| Professional | | $17.38 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,137.96
| Professional | | $891.25 | $1,288.25 | $2,137.96 |