- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,388.44 / $6,025.60
| Facility | | $3,162.28 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,311.31 / $7,244.36
| Professional | | $2,884.03 | $3,311.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,168.69 / $6,456.54
| Professional | | $2,630.27 | $4,168.69 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $6,309.57
| Professional | | $32.36 | $33.11 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,495.41 / $6,760.83
| Professional | | $3,890.45 | $5,495.41 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,786.30 / $6,456.54
| Professional | | $2,754.23 | $4,786.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,466.84 / $6,025.60
| Professional | | $3,630.78 | $4,466.84 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,548.13 / $6,309.57
| Professional | | $2,754.23 | $3,548.13 | $6,309.57 |