- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,897.79 / $8,511.38
| Facility | | $2,041.74 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $3,090.30
| Professional | | $1,122.02 | $1,513.56 | $3,090.30 |
- 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
- $1,258.93 / $1,548.82 / $2,454.71
| Professional | | $1,258.93 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,202.26 / $1,819.70
| Professional | | $1,047.13 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,778.28 / $3,235.94
| Professional | | $912.01 | $1,778.28 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,187.76 / $9,332.54
| Facility | | $54.95 | $2,187.76 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,041.74 / $9,120.11
| Professional | | $1,202.26 | $2,041.74 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $5,370.32
| Facility | | $2,137.96 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $3,235.94
| Professional | | $1,202.26 | $1,819.70 | $3,235.94 |