- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,677.35 / $8,511.38
| Facility | | $1,905.46 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,819.70 / $4,897.79
| Professional | | $1,445.44 | $1,819.70 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,041.74 / $3,162.28
| Professional | | $1,659.59 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $2,511.89
| Professional | | $1,548.82 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,290.87 / $3,630.78
| Professional | | $1,584.89 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,398.83 / $6,165.95
| Facility | | $1,230.27 | $2,398.83 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,398.83 / $16,982.44
| Professional | | $1,621.81 | $2,398.83 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $11,748.98
| Facility | | $2,884.03 | $3,548.13 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $3,162.28
| Professional | | $1,513.56 | $2,041.74 | $3,162.28 |