- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,388.44 / $6,025.60
| Facility | | $2,951.21 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,398.83 / $5,011.87
| Professional | | $1,995.26 | $2,398.83 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,884.03 / $4,677.35
| Professional | | $676.08 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $5,754.40
| Professional | | $32.36 | $33.11 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $4,897.79
| Professional | | $2,884.03 | $3,548.13 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,570.88 / $6,456.54
| Professional | | $2,041.74 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $4,897.79
| Professional | | $2,754.23 | $3,311.31 | $4,897.79 |
- 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
- $1,949.84 / $2,454.71 / $3,890.45
| Professional | | $1,949.84 | $2,454.71 | $3,890.45 |