- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,677.35 / $12,589.25
| Facility | | $2,290.87 | $4,677.35 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,089.30 / $2,630.27
| Professional | | $1,621.81 | $2,089.30 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,570.88 / $13,182.57
| Facility | | $2,089.30 | $4,570.88 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $37.15 / $3,311.31
| Professional | | $33.11 | $37.15 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,570.88 / $11,481.54
| Facility | | $1,778.28 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $7,413.10
| Professional | | $3,162.28 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,691.53 / $3,235.94
| Facility | | $1,621.81 | $2,691.53 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,235.94
| Professional | | $1,148.15 | $1,621.81 | $3,235.94 |