- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,370.32 / $9,549.93
| Facility | | $3,548.13 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,238.72 / $4,168.69
| Professional | | $1,862.09 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,370.32 / $11,220.18
| Facility | | $2,187.76 | $5,370.32 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,548.13 / $5,011.87
| Professional | | $2,137.96 | $3,548.13 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,511.89 / $3,467.37
| Facility | | $501.19 | $2,511.89 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $5,248.07
| Professional | | $2,238.72 | $3,388.44 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,019.95 / $11,481.54
| Professional | | $2,089.30 | $3,019.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,951.21 / $4,677.35
| Professional | | $1,819.70 | $2,951.21 | $4,677.35 |