- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,081.28 / $3,183.13 / $4,260.50
| Facility | | $2,081.28 | $3,183.13 | $4,260.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.91 / $2,130.25 / $2,815.84
| Professional | | $1,860.91 | $2,130.25 | $2,815.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.07 / $1,768.97 / $4,511.84
| Professional | | $9.07 | $1,768.97 | $4,511.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,372.52 / $4,728.52 / $5,836.25
| Facility | | $3,372.52 | $4,728.52 | $5,836.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,841.91 / $2,841.91 / $2,841.91
| Professional | | $2,841.91 | $2,841.91 | $2,841.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,081.28 / $2,938.27 / $11,630.66
| Facility | | $2,081.28 | $2,938.27 | $11,630.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,469.14 / $12,193.83
| Professional | | $1,028.40 | $1,469.14 | $12,193.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,469.14 / $2,769.32
| Professional | | $1,028.40 | $1,469.14 | $2,769.32 |