- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,029.07 / $2,902.02 / $3,018.10
| Facility | | $2,029.07 | $2,902.02 | $3,018.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,591.00 / $3,006.21 / $3,366.95
| Professional | | $2,591.00 | $3,006.21 | $3,366.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,795.92 / $6,097.87 / $6,408.86
| Facility | | $3,795.92 | $6,097.87 | $6,408.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,852.10 / $3,352.62 / $3,643.96
| Professional | | $2,852.10 | $3,352.62 | $3,643.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,573.39 / $8,232.12 / $10,106.85
| Facility | | $4,573.39 | $8,232.12 | $10,106.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,792.98 / $7,622.34 / $10,061.49
| Professional | | $5,792.98 | $7,622.34 | $10,061.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,052.23 / $4,052.23 / $7,323.36
| Facility | | $4,052.23 | $4,052.23 | $7,323.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,958.13 / $4,052.23 / $30,694.43
| Professional | | $2,958.13 | $4,052.23 | $30,694.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,136.22 / $3,824.67 / $4,780.83
| Professional | | $3,136.22 | $3,824.67 | $4,780.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.10 / $3,042.16 / $4,291.35
| Professional | | $2,028.10 | $3,042.16 | $4,291.35 |