- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,388.44 / $6,025.60
| Facility | | $3,019.95 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,691.53 / $10,964.78
| Professional | | $1,778.28 | $2,691.53 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,884.03 / $4,786.30
| Professional | | $1,949.84 | $2,884.03 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $5,495.41
| Professional | | $32.36 | $33.11 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $12,022.64 / $26,302.68
| Facility | | $10,232.93 | $12,022.64 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,981.07 / $6,456.54
| Professional | | $2,630.27 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,801.89 / $5,011.87
| Professional | | $1,819.70 | $3,801.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,311.31 / $5,011.87
| Professional | | $2,511.89 | $3,311.31 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,128.61 / $15,848.93
| Facility | | $3,019.95 | $5,128.61 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,238.72 / $3,548.13
| Professional | | $1,778.28 | $2,238.72 | $3,548.13 |