- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,265.80 / $8,511.38
| Facility | | $1,905.46 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,187.76 / $4,265.80
| Professional | | $1,862.09 | $2,187.76 | $4,265.80 |
- 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
- $2,137.96 / $2,570.40 / $4,073.80
| Professional | | $2,137.96 | $2,570.40 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,089.30 / $3,311.31
| Professional | | $1,862.09 | $2,089.30 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,466.84
| Professional | | $954.99 | $2,884.03 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,951.21 / $15,848.93
| Facility | | $54.95 | $2,951.21 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,162.28 / $17,782.79
| Professional | | $2,041.74 | $3,162.28 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,918.31
| Facility | | $2,454.71 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,511.89 / $4,466.84
| Professional | | $2,041.74 | $2,511.89 | $4,466.84 |