- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,073.80 / $6,025.60
| Facility | | $3,162.28 | $4,073.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $17,378.01
| Professional | | $2,818.38 | $4,073.80 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $7,079.46
| Professional | | $3,090.30 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,454.71
| Professional | | $32.36 | $33.11 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $30,199.52 / $67,608.30
| Facility | | $25,703.96 | $30,199.52 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,309.57 / $8,709.64
| Professional | | $4,168.69 | $6,309.57 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,025.60 / $7,943.28
| Professional | | $2,818.38 | $6,025.60 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,248.07 / $7,413.10
| Professional | | $3,890.45 | $5,248.07 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,128.61 / $24,547.09
| Facility | | $3,311.31 | $5,128.61 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,311.31 / $5,370.32
| Professional | | $2,691.53 | $3,311.31 | $5,370.32 |