- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,715.35 / $7,943.28
| Facility | | $1,778.28 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $3,981.07
| Professional | | $1,288.25 | $1,584.89 | $3,981.07 |
- 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
- $1,348.96 / $1,737.80 / $2,754.23
| Professional | | $1,348.96 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,737.80 / $2,238.72
| Professional | | $1,513.56 | $1,737.80 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,905.46 / $3,090.30
| Professional | | $1,380.38 | $1,905.46 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,290.87 / $10,471.29
| Facility | | $1,348.96 | $2,290.87 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,187.76 / $10,715.19
| Professional | | $1,412.54 | $2,187.76 | $10,715.19 |
- 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
- $1,348.96 / $1,862.09 / $3,090.30
| Professional | | $1,348.96 | $1,862.09 | $3,090.30 |