- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,179.75 / $5,143.71 / $13,923.60
| Facility | | $3,179.75 | $5,143.71 | $13,923.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,320.60 / $2,896.39 / $2,966.19
| Professional | | $2,320.60 | $2,896.39 | $2,966.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.78 / $3,284.18 / $5,202.60
| Facility | | $864.78 | $3,284.18 | $5,202.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.34 / $365.58 / $1,770.80
| Professional | | $251.34 | $365.58 | $1,770.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,331.03 / $5,670.65 / $10,207.17
| Facility | | $2,331.03 | $5,670.65 | $10,207.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,338.05 / $3,489.63 / $6,424.12
| Facility | | $2,338.05 | $3,489.63 | $6,424.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.64 / $1,465.64 / $17,378.36
| Professional | | $1,465.64 | $1,465.64 | $17,378.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.64 / $1,465.64 / $2,093.78
| Professional | | $1,465.64 | $1,465.64 | $2,093.78 |