- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,248.07 / $8,709.64
| Facility | | $2,238.72 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $5,370.32
| Professional | | $2,238.72 | $2,691.53 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,248.07 / $6,309.57
| Professional | | $3,090.30 | $5,248.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,890.45 / $6,918.31
| Professional | | $2,137.96 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $4,677.35
| Facility | | $2,238.72 | $2,691.53 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,467.37
| Professional | | $3,162.28 | $3,162.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,365.16 / $6,309.57
| Professional | | $2,290.87 | $4,365.16 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $52,480.75 / $52,480.75
| Facility | | $56.23 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $19,054.61 / $19,054.61
| Professional | | $15,848.93 | $19,054.61 | $19,054.61 |