- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,888.44 / $19,498.45
| Facility | | $1,380.38 | $5,888.44 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,818.38 / $3,981.07
| Professional | | $2,344.23 | $2,818.38 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $14,454.40
| Facility | | $1,949.84 | $2,630.27 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,365.16 / $17,378.01
| Professional | | $2,818.38 | $4,365.16 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $3,090.30
| Professional | | $2,137.96 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,884.03 / $3,235.94
| Professional | | $2,137.96 | $2,884.03 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,235.94 / $3,630.78
| Facility | | $1,513.56 | $3,235.94 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $5,370.32
| Professional | | $1,258.93 | $1,513.56 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $2,137.96
| Professional | | $977.24 | $2,137.96 | $2,137.96 |