- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,440.35 / $3,859.55 / $6,660.72
| Facility | | $2,440.35 | $3,859.55 | $6,660.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,181.96 / $2,497.77 / $3,301.65
| Professional | | $2,181.96 | $2,497.77 | $3,301.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,871.00 / $3,014.55 / $13,252.54
| Facility | | $2,871.00 | $3,014.55 | $13,252.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.84 / $2,126.78 / $4,508.27
| Professional | | $81.84 | $2,126.78 | $4,508.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.18 / $6,022.07 / $8,646.39
| Facility | | $1,479.18 | $6,022.07 | $8,646.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,307.55 / $2,246.59 / $3,716.35
| Professional | | $1,307.55 | $2,246.59 | $3,716.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.80 / $3,445.20 / $13,637.25
| Facility | | $2,296.80 | $3,445.20 | $13,637.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.82 / $1,722.60 / $14,355.00
| Professional | | $1,205.82 | $1,722.60 | $14,355.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.82 / $1,722.60 / $3,247.10
| Professional | | $1,205.82 | $1,722.60 | $3,247.10 |