- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,332.54 / $17,378.01
| Facility | | $7,079.46 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,691.53
| Professional | | $2,344.23 | $2,344.23 | $2,691.53 |
- 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
- $2,818.38 / $5,370.32 / $5,754.40
| Professional | | $2,818.38 | $5,370.32 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,760.83 / $8,511.38
| Professional | | $1,584.89 | $6,760.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,168.69 / $16,595.87
| Facility | | $1,258.93 | $4,168.69 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $3,890.45
| Professional | | $1,479.11 | $2,089.30 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,162.28 / $5,248.07
| Facility | | $1,584.89 | $3,162.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,089.30 / $3,890.45
| Professional | | $1,995.26 | $2,089.30 | $3,890.45 |