- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,819.70 / $2,511.89
| Facility | | $575.44 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $2,951.21
| Professional | | $1,047.13 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $10,232.93
| Facility | | $7,413.10 | $7,413.10 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $2,454.71
| Professional | | $512.86 | $676.08 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $11,481.54
| Facility | | $1,230.27 | $2,951.21 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,445.44 / $3,090.30
| Professional | | $562.34 | $1,445.44 | $3,090.30 |