- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.38 / $4,310.18 / $7,961.78
| Facility | | $2,008.38 | $4,310.18 | $7,961.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.66 / $1,587.65 / $1,952.62
| Professional | | $1,368.66 | $1,587.65 | $1,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,467.75 / $1,560.45 / $2,340.67
| Facility | | $1,467.75 | $1,560.45 | $2,340.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,913.72 / $1,913.72 / $2,469.79
| Professional | | $1,913.72 | $1,913.72 | $2,469.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.90 / $3,435.15 / $10,431.37
| Facility | | $1,483.90 | $3,435.15 | $10,431.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.91 / $1,742.79 / $3,604.00
| Professional | | $1,055.91 | $1,742.79 | $3,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.90 / $2,372.34 / $3,716.36
| Facility | | $1,459.90 | $2,372.34 | $3,716.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.45 / $1,491.52 / $9,124.40
| Professional | | $766.45 | $1,491.52 | $9,124.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $2,281.10
| Facility | | $1,824.88 | $1,824.88 | $2,281.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.45 / $1,186.17 / $2,737.32
| Professional | | $766.45 | $1,186.17 | $2,737.32 |