- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,388.44 / $5,623.41
| Facility | | $2,630.27 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,089.30 / $2,951.21
| Professional | | $1,047.13 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $15,135.61
| Facility | | $2,137.96 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,995.26 / $14,125.38
| Professional | | $562.34 | $1,995.26 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,235.94 / $8,511.38
| Facility | | $1,995.26 | $3,235.94 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $3,890.45
| Professional | | $2,238.72 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,630.78 / $5,495.41
| Professional | | $2,041.74 | $3,630.78 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,248.07 / $15,135.61
| Facility | | $2,398.83 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,995.26 / $14,125.38
| Professional | | $562.34 | $1,995.26 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $13,182.57
| Facility | | $2,041.74 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $2,344.23 / $5,888.44
| Professional | | $562.34 | $2,344.23 | $5,888.44 |