- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,504.91 / $2,301.62 / $3,080.64
| Facility | | $1,504.91 | $2,301.62 | $3,080.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.91 / $1,540.32 / $2,036.05
| Professional | | $1,504.91 | $1,540.32 | $2,036.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $1,544.79 / $3,262.34
| Professional | | $33.20 | $1,544.79 | $3,262.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,438.57 / $3,419.06 / $4,220.02
| Facility | | $2,438.57 | $3,419.06 | $4,220.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,054.78 / $2,054.78 / $2,054.78
| Professional | | $2,054.78 | $2,054.78 | $2,054.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,504.91 / $2,124.58 / $8,409.78
| Facility | | $1,504.91 | $2,124.58 | $8,409.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.60 / $1,062.29 / $8,816.99
| Professional | | $743.60 | $1,062.29 | $8,816.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.37 / $1,770.48 / $2,124.58
| Facility | | $637.37 | $1,770.48 | $2,124.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.60 / $1,062.29 / $2,002.41
| Professional | | $743.60 | $1,062.29 | $2,002.41 |