- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,467.37 / $6,025.60
| Facility | | $3,162.28 | $3,467.37 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,754.23 / $5,623.41
| Professional | | $2,290.87 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,388.44 / $5,370.32
| Professional | | $1,445.44 | $3,388.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $60.26
| Professional | | $32.36 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,265.80 / $6,165.95
| Professional | | $3,311.31 | $4,265.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,677.35 / $5,754.40
| Professional | | $2,290.87 | $4,677.35 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,715.35 / $5,248.07
| Professional | | $2,884.03 | $3,715.35 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $4,466.84
| Professional | | $2,238.72 | $2,818.38 | $4,466.84 |