- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,511.38 / $16,218.10
| Facility | | $2,290.87 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,454.71 / $3,235.94
| Professional | | $2,137.96 | $2,454.71 | $3,235.94 |
- 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
- $4,677.35 / $5,011.87 / $5,370.32
| Professional | | $4,677.35 | $5,011.87 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,165.95 / $7,762.47
| Professional | | $3,890.45 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,137.96 / $15,488.17
| Facility | | $1,174.90 | $2,137.96 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,949.84 / $9,332.54
| Professional | | $1,348.96 | $1,949.84 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,090.30 / $6,456.54
| Facility | | $1,348.96 | $3,090.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,949.84 / $3,235.94
| Professional | | $1,862.09 | $1,949.84 | $3,235.94 |