- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,801.89 / $5,128.61
| Facility | | $2,951.21 | $3,801.89 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,890.45 / $5,128.61
| Professional | | $2,884.03 | $3,890.45 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $2,630.27
| Facility | | $446.68 | $562.34 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $7,244.36
| Professional | | $2,884.03 | $4,466.84 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $6,309.57 / $23,988.33
| Facility | | $426.58 | $6,309.57 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $6,760.83 / $8,511.38
| Professional | | $478.63 | $6,760.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,511.89 / $4,365.16
| Facility | | $323.59 | $2,511.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,235.94 / $5,623.41
| Professional | | $2,344.23 | $3,235.94 | $5,623.41 |