- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,309.57 / $10,232.93
| Facility | | $2,089.30 | $6,309.57 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,737.80 / $2,290.87
| Professional | | $1,148.15 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,570.40 / $7,943.28
| Professional | | $2,454.71 | $2,570.40 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,022.64 / $18,620.87
| Facility | | $8,317.64 | $12,022.64 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,949.84 / $4,897.79
| Facility | | $1,023.29 | $1,949.84 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,089.30 / $4,168.69
| Professional | | $1,659.59 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,238.72 / $5,495.41
| Facility | | $1,318.26 | $2,238.72 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $2,884.03
| Professional | | $1,548.82 | $1,949.84 | $2,884.03 |