- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,025.60 / $9,772.37
| Facility | | $1,737.80 | $6,025.60 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,047.13 / $1,380.38
| Professional | | $676.08 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,011.87 / $8,511.38
| Facility | | $2,238.72 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,737.80
| Professional | | $724.44 | $724.44 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,122.02 / $5,370.32
| Facility | | $933.25 | $1,122.02 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,570.40
| Professional | | $2,137.96 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $1,737.80
| Professional | | $1,230.27 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $724.44
| Professional | | $467.74 | $467.74 | $724.44 |