- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,041.56 / $5,051.95 / $8,726.94
| Facility | | $4,041.56 | $5,051.95 | $8,726.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,041.56 / $4,041.56 / $4,041.56
| Professional | | $4,041.56 | $4,041.56 | $4,041.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.45 / $500.30 / $975.56
| Facility | | $383.45 | $500.30 | $975.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,767.88 / $3,926.53 / $3,966.19
| Professional | | $3,767.88 | $3,926.53 | $3,966.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,933.75 / $4,917.18 / $9,581.54
| Professional | | $3,933.75 | $4,917.18 | $9,581.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.39 / $4,291.50 / $18,944.81
| Facility | | $1,031.39 | $4,291.50 | $18,944.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,209.96 / $4,209.96 / $6,314.94
| Professional | | $4,209.96 | $4,209.96 | $6,314.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,701.79 / $5,052.77 / $9,321.06
| Facility | | $1,701.79 | $5,052.77 | $9,321.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,052.77 / $6,337.76 / $10,015.61
| Professional | | $5,052.77 | $6,337.76 | $10,015.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,999.46 / $4,209.96 / $5,051.95
| Professional | | $3,999.46 | $4,209.96 | $5,051.95 |