- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,365.16 / $10,471.29
| Facility | | $2,754.23 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $7,585.78
| Professional | | $2,570.40 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,715.35 / $7,079.46
| Professional | | $2,137.96 | $3,715.35 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,073.80 / $6,918.31
| Professional | | $2,754.23 | $4,073.80 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,548.13 / $5,495.41
| Facility | | $2,754.23 | $3,548.13 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $5,370.32 / $7,244.36
| Professional | | $10.96 | $5,370.32 | $7,244.36 |
- 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
- $2,454.71 / $3,162.28 / $6,309.57
| Professional | | $2,454.71 | $3,162.28 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $38,018.94 / $38,018.94
| Facility | | $56.23 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $25,118.86
| Professional | | $19,952.62 | $19,952.62 | $25,118.86 |