- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,890.45 / $6,025.60
| Facility | | $3,162.28 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $7,943.28
| Professional | | $2,511.89 | $2,884.03 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $3,630.78 / $5,754.40
| Professional | | $776.25 | $3,630.78 | $5,754.40 |
- 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
- $3,548.13 / $4,466.84 / $6,025.60
| Professional | | $3,548.13 | $4,466.84 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,623.41 / $7,943.28
| Professional | | $2,398.83 | $5,623.41 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,981.07 / $5,495.41
| Professional | | $3,311.31 | $3,981.07 | $5,495.41 |
- 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
- $2,398.83 / $3,090.30 / $5,011.87
| Professional | | $2,398.83 | $3,090.30 | $5,011.87 |