- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,467.37 / $5,248.07
| Facility | | $2,570.40 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $4,570.88
| Professional | | $2,398.83 | $3,388.44 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $10,964.78
| Facility | | $323.59 | $323.59 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $6,025.60
| Professional | | $3,090.30 | $4,365.16 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $5,754.40
| Facility | | $3,311.31 | $3,311.31 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,311.31 / $8,511.38
| Professional | | $2,818.38 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,187.76 / $4,265.80
| Facility | | $263.03 | $2,187.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $4,897.79
| Professional | | $1,995.26 | $2,884.03 | $4,897.79 |