- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,235.94 / $7,413.10
| Facility | | $1,513.56 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $3,388.44
| Professional | | $1,023.29 | $1,202.26 | $3,388.44 |
- 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
- $1,148.15 / $1,412.54 / $2,137.96
| Professional | | $1,148.15 | $1,412.54 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $1,737.80
| Professional | | $1,071.52 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $2,454.71
| Professional | | $1,047.13 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,819.70 / $7,079.46
| Facility | | $1,047.13 | $1,819.70 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $8,709.64
| Professional | | $1,122.02 | $1,778.28 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,019.95 / $5,248.07
| Facility | | $1,479.11 | $3,019.95 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,398.83
| Professional | | $1,047.13 | $1,513.56 | $2,398.83 |