- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $5,248.07
| Facility | | $933.25 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,128.61 / $8,912.51
| Professional | | $3,548.13 | $5,128.61 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,079.46 / $10,471.29
| Facility | | $4,265.80 | $7,079.46 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,011.87 / $6,309.57
| Professional | | $2,884.03 | $5,011.87 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,905.46 / $10,964.78
| Facility | | $524.81 | $1,905.46 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,570.88 / $7,413.10
| Professional | | $3,311.31 | $4,570.88 | $7,413.10 |