- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.81 / $4,232.64 / $7,069.21
| Facility | | $2,712.81 | $4,232.64 | $7,069.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.48 / $2,789.47 / $4,067.00
| Professional | | $2,137.48 | $2,789.47 | $4,067.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,810.98 / $7,248.41 / $11,848.31
| Facility | | $1,810.98 | $7,248.41 | $11,848.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.38 / $2,012.19 / $13,462.31
| Professional | | $1,383.38 | $2,012.19 | $13,462.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.53 / $2,116.32 / $2,116.32
| Facility | | $1,996.53 | $2,116.32 | $2,116.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,116.32
| Professional | | $2,116.32 | $2,116.32 | $2,116.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.13 / $2,557.02 / $3,324.12
| Facility | | $1,143.13 | $2,557.02 | $3,324.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.23 / $2,113.23 / $2,113.23
| Professional | | $2,113.23 | $2,113.23 | $2,113.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,116.32
| Professional | | $2,116.32 | $2,116.32 | $2,116.32 |