- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.70 / $4,559.05 / $8,625.21
| Facility | | $2,748.70 | $4,559.05 | $8,625.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,211.59 / $2,559.13 / $2,748.70
| Professional | | $2,211.59 | $2,559.13 | $2,748.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,696.52 / $4,423.18 / $5,592.17
| Facility | | $3,696.52 | $4,423.18 | $5,592.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.55 / $3,232.03 / $12,321.74
| Facility | | $1,749.55 | $3,232.03 | $12,321.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.65 / $1,895.65 / $2,685.51
| Professional | | $1,895.65 | $1,895.65 | $2,685.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.60 / $1,251.68 / $3,159.42
| Professional | | $1,239.60 | $1,251.68 | $3,159.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.53 / $2,053.62 / $5,135.08
| Professional | | $1,437.53 | $2,053.62 | $5,135.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.50 / $4,900.70 / $9,825.15
| Facility | | $2,432.50 | $4,900.70 | $9,825.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,794.43 / $3,848.09 / $4,610.43
| Professional | | $3,794.43 | $3,848.09 | $4,610.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,001.45 / $3,001.45 / $3,001.45
| Facility | | $3,001.45 | $3,001.45 | $3,001.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,633.33
| Professional | | $1,326.96 | $1,895.65 | $3,633.33 |