- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,897.79 / $6,918.31
| Facility | | $2,951.21 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,344.23 / $4,265.80
| Professional | | $1,949.84 | $2,344.23 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,467.37 / $3,467.37
| Facility | | $588.84 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $3,467.37 / $3,630.78
| Professional | | $758.58 | $3,467.37 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,691.53 / $6,456.54
| Professional | | $1,737.80 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,897.79 / $7,079.46
| Facility | | $2,951.21 | $4,897.79 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,630.27 / $3,630.78
| Professional | | $2,089.30 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $4,168.69
| Professional | | $1,659.59 | $2,511.89 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,943.28 / $14,791.08
| Facility | | $4,073.80 | $7,943.28 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $3,630.78
| Professional | | $2,187.76 | $2,754.23 | $3,630.78 |