- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,370.32 / $9,549.93
| Facility | | $3,890.45 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $5,248.07
| Professional | | $2,630.27 | $3,311.31 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,025.60 / $12,302.69
| Facility | | $2,238.72 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,570.88 / $6,918.31
| Professional | | $2,884.03 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $5,128.61 / $58,884.37
| Facility | | $501.19 | $5,128.61 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,570.88 / $7,762.47
| Professional | | $3,019.95 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,786.30 / $16,218.10
| Professional | | $3,235.94 | $4,786.30 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Professional | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,235.94 / $7,943.28
| Facility | | $630.96 | $3,235.94 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,801.89 / $6,760.83
| Professional | | $2,454.71 | $3,801.89 | $6,760.83 |