- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $8,912.51
| Facility | | $2,137.96 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $3,388.44
| Professional | | $2,089.30 | $2,570.40 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $3,235.94 / $4,073.80
| Facility | | $15.14 | $3,235.94 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $3,235.94 / $3,235.94
| Professional | | $7.41 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,079.46 / $9,772.37
| Facility | | $5,011.87 | $7,079.46 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $4,466.84
| Professional | | $2,884.03 | $3,548.13 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,265.80 / $6,760.83
| Professional | | $3,235.94 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,235.94
| Facility | | $2,884.03 | $2,884.03 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $4,365.16
| Professional | | $1,348.96 | $1,905.46 | $4,365.16 |