- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.67 / $3,374.53 / $5,823.69
| Facility | | $2,133.67 | $3,374.53 | $5,823.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,907.76 / $2,183.88 / $2,886.74
| Professional | | $1,907.76 | $2,183.88 | $2,886.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,635.72 / $11,587.13
| Facility | | $2,510.21 | $2,635.72 | $11,587.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.60 / $2,234.02 / $5,426.95
| Professional | | $1,239.60 | $2,234.02 | $5,426.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,861.94 / $4,725.22 / $6,118.65
| Facility | | $2,861.94 | $4,725.22 | $6,118.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.22 / $2,182.57 / $2,913.24
| Professional | | $1,143.22 | $2,182.57 | $2,913.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,183.88 / $3,137.76 / $11,923.50
| Facility | | $2,183.88 | $3,137.76 | $11,923.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,859.41 / $12,551.05
| Professional | | $1,054.29 | $1,859.41 | $12,551.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,580.50 / $3,253.23
| Professional | | $1,054.29 | $1,580.50 | $3,253.23 |