- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,025.60 / $15,488.17
| Facility | | $2,344.23 | $6,025.60 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,290.87 / $2,951.21
| Professional | | $1,995.26 | $2,290.87 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,165.95 / $9,332.54
| Facility | | $1,905.46 | $6,165.95 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,019.95 / $5,754.40
| Professional | | $2,884.03 | $3,019.95 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,344.23 / $8,511.38
| Facility | | $1,819.70 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,019.95 / $5,495.41
| Facility | | $2,041.74 | $3,019.95 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $15,135.61
| Professional | | $1,258.93 | $1,258.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,019.95 / $3,630.78
| Facility | | $2,754.23 | $3,019.95 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,819.70
| Professional | | $1,258.93 | $1,258.93 | $1,819.70 |