- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,369.51 / $6,739.02 / $8,985.36
| Facility | | $3,369.51 | $6,739.02 | $8,985.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,292.05 / $3,369.51 / $4,144.10
| Professional | | $3,292.05 | $3,369.51 | $4,144.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.16 / $2,556.17 / $7,857.27
| Professional | | $720.16 | $2,556.17 | $7,857.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,467.90 / $7,560.34 / $9,231.49
| Facility | | $5,467.90 | $7,560.34 | $9,231.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,763.89 / $2,422.69 / $4,494.99
| Professional | | $1,763.89 | $2,422.69 | $4,494.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.05 / $4,647.60 / $18,396.75
| Facility | | $3,292.05 | $4,647.60 | $18,396.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $19,287.54
| Professional | | $1,626.66 | $2,323.80 | $19,287.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $4,380.35
| Professional | | $1,626.66 | $2,323.80 | $4,380.35 |