- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,890.45 / $9,120.11
| Facility | | $2,398.83 | $3,890.45 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,570.40 / $7,244.36
| Professional | | $2,187.76 | $2,570.40 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,981.07 / $6,309.57
| Professional | | $2,818.38 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,715.35 / $6,025.60
| Professional | | $2,754.23 | $3,715.35 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,311.31 / $5,248.07
| Facility | | $2,398.83 | $3,311.31 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $4,570.88 / $6,165.95
| Professional | | $10.96 | $4,570.88 | $6,165.95 |
- 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 / $3,162.28 / $5,495.41
| Professional | | $2,290.87 | $3,162.28 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $33,113.11 / $33,113.11
| Facility | | $56.23 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $20,417.38
| Professional | | $17,378.01 | $17,378.01 | $20,417.38 |