- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,025.60 / $8,709.64
| Facility | | $3,162.28 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,884.03 / $12,302.69
| Professional | | $1,949.84 | $2,884.03 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $5,011.87
| Professional | | $2,137.96 | $3,162.28 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $4,570.88
| Professional | | $32.36 | $33.11 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,772.37 / $21,379.62
| Facility | | $8,317.64 | $9,772.37 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,466.84 / $6,165.95
| Professional | | $2,951.21 | $4,466.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,168.69 / $5,623.41
| Professional | | $1,949.84 | $4,168.69 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,715.35 / $5,370.32
| Professional | | $2,754.23 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,398.83 / $3,715.35
| Professional | | $1,949.84 | $2,398.83 | $3,715.35 |