- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,309.57 / $10,471.29
| Facility | | $3,162.28 | $6,309.57 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,388.44 / $4,365.16
| Professional | | $2,511.89 | $3,388.44 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,090.30 / $5,128.61
| Professional | | $2,344.23 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $1,949.84 / $5,623.41
| Facility | | $54.95 | $1,949.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $19,952.62
| Professional | | $2,398.83 | $2,884.03 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,778.28 / $5,623.41
| Facility | | $912.01 | $1,778.28 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $3,890.45
| Professional | | $2,398.83 | $2,884.03 | $3,890.45 |