- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,222.13 / $3,386.11 / $8,072.36
| Facility | | $2,222.13 | $3,386.11 | $8,072.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,926.74 / $2,137.48 / $2,666.56
| Professional | | $1,926.74 | $2,137.48 | $2,666.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.73 / $1,927.16 / $3,094.03
| Facility | | $993.73 | $1,927.16 | $3,094.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,426.55 / $2,894.07
| Professional | | $2,116.32 | $2,426.55 | $2,894.07 |
- 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
- $827.56 / $2,222.14 / $5,266.28
| Facility | | $827.56 | $2,222.14 | $5,266.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,251.57 / $3,251.57 / $3,251.57
| Professional | | $3,251.57 | $3,251.57 | $3,251.57 |
- 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 |