- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,370.32 / $9,549.93
| Facility | | $3,715.35 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,162.28 / $6,025.60
| Professional | | $2,454.71 | $3,162.28 | $6,025.60 |
- 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
- $2,691.53 / $4,365.16 / $6,456.54
| Professional | | $2,691.53 | $4,365.16 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $4,786.30 / $58,884.37
| Facility | | $501.19 | $4,786.30 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $7,413.10
| Professional | | $2,951.21 | $4,365.16 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,466.84 / $15,488.17
| Professional | | $3,090.30 | $4,466.84 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Professional | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,912.51 / $19,498.45
| Facility | | $2,290.87 | $8,912.51 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,630.78 / $6,456.54
| Professional | | $2,344.23 | $3,630.78 | $6,456.54 |