- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $13,489.63 / $19,054.61
| Facility | | $3,548.13 | $13,489.63 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,090.30 / $7,413.10
| Professional | | $2,570.40 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,079.46 / $10,471.29
| Facility | | $2,187.76 | $7,079.46 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,388.44 / $6,456.54
| Professional | | $3,235.94 | $3,388.44 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,801.89 / $12,589.25
| Facility | | $2,398.83 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,467.37 / $5,248.07
| Professional | | $1,778.28 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,073.80 / $6,918.31
| Facility | | $2,570.40 | $4,073.80 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $19,498.45
| Professional | | $1,621.81 | $1,621.81 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,890.45 / $4,677.35
| Facility | | $3,467.37 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $2,344.23
| Professional | | $1,621.81 | $1,621.81 | $2,344.23 |