- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,248.07 / $8,511.38
| Facility | | $2,454.71 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,174.90 / $2,691.53
| Professional | | $954.99 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $2,089.30
| Professional | | $1,047.13 | $1,348.96 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,071.52 / $1,737.80
| Professional | | $977.24 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,445.44 / $2,290.87
| Professional | | $426.58 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,090.30 / $26,302.68
| Facility | | $1,023.29 | $3,090.30 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $8,511.38
| Professional | | $1,047.13 | $1,584.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,165.95
| Facility | | $2,454.71 | $3,715.35 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,288.25 / $2,187.76
| Professional | | $1,023.29 | $1,288.25 | $2,187.76 |