- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.42 / $3,672.84 / $7,345.68
| Facility | | $1,836.42 | $3,672.84 | $7,345.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,836.42 / $2,938.27 / $15,744.20
| Professional | | $1,836.42 | $2,938.27 | $15,744.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.90 / $2,002.92 / $2,448.56
| Professional | | $1,301.90 | $2,002.92 | $2,448.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.56 / $1,591.56 / $1,591.56
| Facility | | $1,591.56 | $1,591.56 | $1,591.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,193.76 / $2,813.77 / $3,517.21
| Professional | | $2,193.76 | $2,813.77 | $3,517.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.71 / $3,795.27 / $3,991.15
| Professional | | $1,346.71 | $3,795.27 | $3,991.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.97 / $2,326.13 / $2,938.27
| Facility | | $521.97 | $2,326.13 | $2,938.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.47 / $2,815.84 / $3,403.50
| Professional | | $1,326.47 | $2,815.84 | $3,403.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,448.56 / $2,448.56
| Facility | | $2,448.56 | $2,448.56 | $2,448.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.88 / $252.88 / $1,469.14
| Professional | | $252.88 | $252.88 | $1,469.14 |