- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,090.30 / $9,332.54
| Facility | | $2,344.23 | $3,090.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $2,454.71 / $3,890.45
| Professional | | $323.59 | $2,454.71 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Professional | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $8,317.64
| Facility | | $2,041.74 | $2,041.74 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,801.89 / $4,570.88
| Professional | | $1,380.38 | $3,801.89 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,090.30 / $5,370.32
| Facility | | $2,290.87 | $3,090.30 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $4,677.35
| Professional | | $1,318.26 | $1,318.26 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,090.30 / $3,715.35
| Facility | | $1,318.26 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $2,041.74
| Professional | | $1,318.26 | $1,318.26 | $2,041.74 |