- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $10,232.93
| Facility | | $2,454.71 | $6,456.54 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,951.21 / $3,548.13
| Professional | | $2,454.71 | $2,951.21 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,981.07 / $4,677.35
| Facility | | $2,630.27 | $3,981.07 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $3,715.35
| Professional | | $1,513.56 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,128.31 / $11,220.18
| Facility | | $5,754.40 | $8,128.31 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $8,912.51 / $20,892.96
| Professional | | $1,819.70 | $8,912.51 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,265.80 / $8,511.38
| Professional | | $3,311.31 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,570.88 / $7,762.47
| Professional | | $3,715.35 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,715.35
| Facility | | $3,311.31 | $3,311.31 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $5,011.87
| Professional | | $1,548.82 | $2,187.76 | $5,011.87 |