- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,265.80 / $8,511.38
| Facility | | $2,290.87 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,467.37 / $7,943.28
| Professional | | $2,818.38 | $3,467.37 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,890.45 / $5,888.44
| Professional | | $3,162.28 | $3,890.45 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,548.13 / $5,128.61
| Professional | | $3,090.30 | $3,548.13 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,168.69 / $6,918.31
| Professional | | $2,884.03 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,265.80 / $9,120.11
| Facility | | $1,288.25 | $4,265.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,466.84 / $25,118.86
| Professional | | $3,090.30 | $4,466.84 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $11,748.98
| Facility | | $2,884.03 | $3,548.13 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,890.45 / $6,309.57
| Professional | | $2,884.03 | $3,890.45 | $6,309.57 |