- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.23 / $6,443.65 / $8,555.84
| Facility | | $3,630.23 | $6,443.65 | $8,555.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,171.94 / $3,025.19 / $7,562.98
| Professional | | $2,171.94 | $3,025.19 | $7,562.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.50 / $3,878.45 / $9,308.28
| Facility | | $1,260.50 | $3,878.45 | $9,308.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $239.16 / $2,009.03
| Professional | | $239.16 | $239.16 | $2,009.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.98 / $4,537.78 / $6,302.48
| Facility | | $2,520.98 | $4,537.78 | $6,302.48 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $3,878.45 / $3,878.45 / $4,072.37
| Professional | | $3,878.45 | $3,878.45 | $4,072.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.95 / $1,628.95 / $3,878.45
| Professional | | $1,628.95 | $1,628.95 | $3,878.45 |