- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,394.07 / $3,357.54 / $10,773.30
| Facility | | $2,394.07 | $3,357.54 | $10,773.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,160.50 / $2,394.07 / $2,481.66
| Professional | | $2,160.50 | $2,394.07 | $2,481.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.83 / $8,758.79 / $15,850.51
| Facility | | $1,167.83 | $8,758.79 | $15,850.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $1,167.83 / $1,576.58
| Professional | | $846.27 | $1,167.83 | $1,576.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.60 / $3,795.48 / $4,671.35
| Facility | | $2,919.60 | $3,795.48 | $4,671.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $3,503.52 / $4,379.39
| Professional | | $2,919.60 | $3,503.52 | $4,379.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.74 / $2,919.60 / $6,507.15
| Facility | | $1,897.74 | $2,919.60 | $6,507.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.55 / $3,556.09 / $4,260.59
| Professional | | $1,541.55 | $3,556.09 | $4,260.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $3,503.52
| Facility | | $2,919.60 | $2,919.60 | $3,503.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $3,208.64
| Professional | | $1,226.23 | $1,751.76 | $3,208.64 |