- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,260.48 / $3,266.08 / $7,845.81
| Facility | | $2,260.48 | $3,266.08 | $7,845.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,822.13 / $2,260.48 / $2,406.59
| Professional | | $1,822.13 | $2,260.48 | $2,406.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.88 / $5,045.24 / $8,509.00
| Facility | | $351.88 | $5,045.24 | $8,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.71 / $1,001.44 / $2,269.06
| Professional | | $770.71 | $1,001.44 | $2,269.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.69 / $9,533.12 / $19,733.57
| Facility | | $2,234.69 | $9,533.12 | $19,733.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,406.59 / $5,406.22 / $8,491.81
| Professional | | $2,406.59 | $5,406.22 | $8,491.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.47 / $2,062.79 / $6,033.31
| Professional | | $1,581.47 | $2,062.79 | $6,033.31 |