- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,436.94 / $2,769.25 / $6,203.12
| Facility | | $2,436.94 | $2,769.25 | $6,203.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.16 / $1,329.24 / $1,883.09
| Professional | | $1,174.16 | $1,329.24 | $1,883.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $336.26 / $2,057.48
| Professional | | $336.26 | $336.26 | $2,057.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,658.48 / $2,658.48 / $2,658.48
| Facility | | $2,658.48 | $2,658.48 | $2,658.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,698.48 / $3,233.08 / $10,678.23
| Professional | | $2,698.48 | $3,233.08 | $10,678.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.78 / $2,724.94 / $4,807.42
| Professional | | $1,550.78 | $2,724.94 | $4,807.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,883.09 / $2,188.01 / $4,017.17
| Professional | | $1,883.09 | $2,188.01 | $4,017.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,658.48 / $2,658.48 / $2,658.48
| Facility | | $2,658.48 | $2,658.48 | $2,658.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.01 / $2,038.17 / $5,095.42
| Professional | | $1,440.01 | $2,038.17 | $5,095.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.47 / $1,329.24 / $3,253.82
| Professional | | $930.47 | $1,329.24 | $3,253.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,104.63 / $2,322.54 / $6,399.62
| Professional | | $2,104.63 | $2,322.54 | $6,399.62 |