- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,370.32 / $7,943.28
| Facility | | $1,819.70 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,819.70 / $2,137.96
| Professional | | $660.69 | $1,819.70 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,630.78 / $3,715.35
| Facility | | $3,467.37 | $3,630.78 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,754.23 / $2,951.21
| Professional | | $2,238.72 | $2,754.23 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $2,238.72 / $3,019.95
| Professional | | $416.87 | $2,238.72 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,623.41 / $18,197.01
| Facility | | $1,819.70 | $5,623.41 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $2,691.53 / $6,456.54
| Professional | | $933.25 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,951.21 / $4,466.84
| Professional | | $2,238.72 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,549.93 / $19,498.45
| Facility | | $5,495.41 | $9,549.93 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $5,495.41
| Professional | | $954.99 | $2,344.23 | $5,495.41 |