- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,786.30 / $7,079.46
| Facility | | $2,187.76 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $3,467.37
| Professional | | $1,258.93 | $1,584.89 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $3,981.07
| Professional | | $2,454.71 | $3,235.94 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,819.70 / $7,079.46
| Professional | | $1,230.27 | $1,819.70 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,548.13 / $14,454.40
| Facility | | $2,041.74 | $3,548.13 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,630.27 / $13,182.57
| Professional | | $1,380.38 | $2,630.27 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,235.94 / $3,630.78
| Professional | | $2,630.27 | $3,235.94 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,884.03 / $3,630.78
| Professional | | $2,691.53 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,964.78 / $15,848.93
| Facility | | $7,413.10 | $10,964.78 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,995.26 / $3,890.45
| Professional | | $1,318.26 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,630.27 / $3,090.30
| Professional | | $2,089.30 | $2,630.27 | $3,090.30 |