- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,897.79 / $8,511.38
| Facility | | $2,187.76 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,884.03 / $8,511.38
| Professional | | $2,238.72 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,244.36 / $14,454.40
| Facility | | $2,238.72 | $7,244.36 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,162.28 / $4,677.35
| Professional | | $2,511.89 | $3,162.28 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,951.21 / $4,168.69
| Professional | | $2,570.40 | $2,951.21 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,467.37 / $5,623.41
| Professional | | $2,398.83 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,890.45 / $10,471.29
| Facility | | $2,187.76 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,981.07 / $18,620.87
| Professional | | $2,454.71 | $3,981.07 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,818.38 / $11,220.18
| Facility | | $1,380.38 | $2,818.38 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $5,370.32
| Professional | | $2,344.23 | $3,311.31 | $5,370.32 |