- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,244.36 / $18,620.87
| Facility | | $2,754.23 | $7,244.36 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,818.38 / $3,467.37
| Professional | | $2,344.23 | $2,818.38 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,897.79 / $7,244.36
| Facility | | $1,513.56 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,162.28 / $6,025.60
| Professional | | $3,019.95 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,754.23 / $7,585.78
| Facility | | $2,137.96 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,630.78 / $6,918.31
| Facility | | $2,398.83 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $17,782.79
| Professional | | $1,513.56 | $1,513.56 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,630.78 / $4,365.16
| Facility | | $3,235.94 | $3,630.78 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,137.96
| Professional | | $1,513.56 | $1,513.56 | $2,137.96 |