- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,190.02 / $5,090.46 / $10,571.10
| Facility | | $3,190.02 | $5,090.46 | $10,571.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,714.92 / $3,180.33 / $3,490.61
| Professional | | $2,714.92 | $3,180.33 | $3,490.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.24 / $5,691.63 / $15,125.96
| Facility | | $502.24 | $5,691.63 | $15,125.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $239.16 / $2,520.98
| Professional | | $239.16 | $239.16 | $2,520.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,233.17 / $5,251.21 / $11,492.65
| Facility | | $3,233.17 | $5,251.21 | $11,492.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,724.08 / $4,724.08 / $5,659.99
| Professional | | $4,724.08 | $4,724.08 | $5,659.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.45 / $3,878.45 / $3,878.45
| Facility | | $3,878.45 | $3,878.45 | $3,878.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.95 / $2,327.07 / $4,460.22
| Professional | | $1,628.95 | $2,327.07 | $4,460.22 |