- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,762.47 / $9,772.37
| Facility | | $2,398.83 | $7,762.47 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $4,677.35
| Professional | | $2,041.74 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,964.78 / $16,982.44
| Facility | | $3,890.45 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $6,606.93
| Professional | | $2,137.96 | $4,466.84 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $3,311.31 / $6,165.95
| Professional | | $691.83 | $3,311.31 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,548.13 / $5,623.41
| Professional | | $2,454.71 | $3,548.13 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,467.37 / $6,165.95
| Professional | | $2,344.23 | $3,467.37 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $2,818.38
| Facility | | $1,698.24 | $2,398.83 | $2,818.38 |