- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,691.53 / $6,456.54
| Facility | | $1,096.48 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $2,238.72
| Professional | | $1,071.52 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,073.80 / $5,888.44
| Facility | | $2,137.96 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,659.59 / $2,754.23
| Professional | | $1,174.90 | $1,659.59 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $2,238.72
| Professional | | $1,047.13 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $33,884.42
| Facility | | $8,912.51 | $8,912.51 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,471.29 / $10,471.29
| Professional | | $9,120.11 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,570.88 / $7,585.78
| Facility | | $2,754.23 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $2,344.23
| Professional | | $1,071.52 | $1,348.96 | $2,344.23 |