- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $16,595.87
| Facility | | $2,454.71 | $6,456.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $3,090.30
| Professional | | $1,995.26 | $2,454.71 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,754.40 / $8,709.64
| Facility | | $1,778.28 | $5,754.40 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,818.38 / $5,370.32
| Professional | | $2,691.53 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,454.71 / $6,760.83
| Facility | | $1,905.46 | $2,454.71 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,235.94 / $6,025.60
| Facility | | $2,137.96 | $3,235.94 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $15,848.93
| Professional | | $1,348.96 | $1,348.96 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,235.94 / $3,801.89
| Facility | | $2,884.03 | $3,235.94 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,905.46
| Professional | | $1,348.96 | $1,348.96 | $1,905.46 |