- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,235.94 / $7,762.47
| Facility | | $2,344.23 | $3,235.94 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $10,964.78
| Professional | | $2,187.76 | $2,754.23 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,630.27 / $3,890.45
| Professional | | $1,737.80 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,090.30
| Professional | | $32.36 | $33.11 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $8,128.31
| Facility | | $1,513.56 | $2,137.96 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,290.87 / $3,890.45
| Professional | | $1,737.80 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $19,498.45
| Facility | | $3,090.30 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,398.83 / $4,365.16
| Professional | | $1,659.59 | $2,398.83 | $4,365.16 |