- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,715.35 / $9,772.37
| Facility | | $1,778.28 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,737.80 / $2,290.87
| Professional | | $1,412.54 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,548.13 / $10,715.19
| Facility | | $1,548.82 | $3,548.13 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $25.12 / $2,754.23
| Professional | | $21.38 | $25.12 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,467.37 / $9,332.54
| Facility | | $1,380.38 | $3,467.37 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,090.30 / $5,888.44
| Professional | | $2,454.71 | $3,090.30 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,137.96 / $2,570.40
| Facility | | $891.25 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,570.40
| Professional | | $891.25 | $1,288.25 | $2,570.40 |