- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.91 / $3,841.74 / $6,715.56
| Facility | | $1,386.91 | $3,841.74 | $6,715.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.91 / $1,501.96 / $2,737.32
| Professional | | $1,386.91 | $1,501.96 | $2,737.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,928.53 / $5,091.42 / $8,394.45
| Facility | | $1,928.53 | $5,091.42 | $8,394.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.44 / $766.44 / $1,824.88
| Professional | | $766.44 | $766.44 | $1,824.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.83 / $1,221.76 / $5,575.00
| Facility | | $1,043.83 | $1,221.76 | $5,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.49 / $1,337.65 / $3,205.57
| Professional | | $942.49 | $1,337.65 | $3,205.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.91 / $1,983.28 / $2,858.74
| Facility | | $1,386.91 | $1,983.28 | $2,858.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.90 / $2,591.33 / $4,379.71
| Professional | | $1,459.90 | $2,591.33 | $4,379.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $2,237.27
| Facility | | $1,824.88 | $1,824.88 | $2,237.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.45 / $1,044.06 / $1,094.93
| Professional | | $766.45 | $1,044.06 | $1,094.93 |