- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,137.96 / $3,090.30
| Facility | | $2,041.74 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,137.96 / $2,137.96
| Professional | | $1,698.24 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,943.28 / $19,054.61
| Facility | | $5,623.41 | $7,943.28 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $3,162.28
| Professional | | $2,511.89 | $2,884.03 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,943.28 / $15,135.61
| Facility | | $6,165.95 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $3,388.44
| Professional | | $2,454.71 | $2,454.71 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,137.96 / $4,365.16
| Facility | | $776.25 | $2,137.96 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $851.14 / $2,290.87
| Professional | | $524.81 | $851.14 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $1,071.52 / $2,187.76
| Facility | | $12.59 | $1,071.52 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $2,454.71
| Professional | | $524.81 | $891.25 | $2,454.71 |