- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $6,025.60
| Facility | | $3,162.28 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $6,918.31
| Professional | | $2,344.23 | $2,884.03 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $5,888.44
| Professional | | $2,290.87 | $3,548.13 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $7,762.47
| Professional | | $32.36 | $33.11 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,309.57 / $14,791.08
| Professional | | $4,466.84 | $6,309.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,309.57 / $8,317.64
| Professional | | $2,290.87 | $6,309.57 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,677.35 / $6,456.54
| Professional | | $3,801.89 | $4,677.35 | $6,456.54 |
- 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
- $2,454.71 / $3,090.30 / $5,495.41
| Professional | | $2,454.71 | $3,090.30 | $5,495.41 |