- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.59 / $4,492.68 / $16,290.20
| Facility | | $2,975.59 | $4,492.68 | $16,290.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.58 / $2,264.01 / $6,035.28
| Professional | | $1,863.58 | $2,264.01 | $6,035.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,452.00 / $4,552.18 / $9,585.68
| Facility | | $3,452.00 | $4,552.18 | $9,585.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.23 / $3,641.74 / $6,594.17
| Professional | | $1,975.23 | $3,641.74 | $6,594.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,617.81 / $3,921.17 / $15,816.40
| Facility | | $2,617.81 | $3,921.17 | $15,816.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.77 / $4,807.49 / $8,668.95
| Professional | | $2,147.77 | $4,807.49 | $8,668.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $5,128.99 / $7,358.70
| Professional | | $2,711.10 | $5,128.99 | $7,358.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,781.58 / $2,481.82 / $6,861.02
| Professional | | $1,781.58 | $2,481.82 | $6,861.02 |