- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.91 / $5,154.72 / $9,010.70
| Facility | | $1,860.91 | $5,154.72 | $9,010.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.21 / $1,860.91 / $2,361.19
| Professional | | $508.21 | $1,860.91 | $2,361.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,588.13 / $7,051.85 / $11,214.40
| Facility | | $2,588.13 | $7,051.85 | $11,214.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.39 / $1,028.39 / $2,448.56
| Professional | | $1,028.39 | $1,028.39 | $2,448.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.40 / $2,148.61 / $6,302.58
| Facility | | $1,432.40 | $2,148.61 | $6,302.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.69 / $1,666.25 / $3,550.00
| Professional | | $648.69 | $1,666.25 | $3,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.91 / $2,448.56 / $3,427.98
| Facility | | $1,860.91 | $2,448.56 | $3,427.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,836.42 / $3,427.98 / $5,876.54
| Professional | | $1,836.42 | $3,427.98 | $5,876.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,672.84 / $3,672.84 / $3,672.84
| Facility | | $3,672.84 | $3,672.84 | $3,672.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.88 / $1,028.40 / $1,469.14
| Professional | | $252.88 | $1,028.40 | $1,469.14 |