- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,548.13 / $5,495.41
| Facility | | $2,630.27 | $3,548.13 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $4,570.88
| Professional | | $2,454.71 | $3,467.37 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $10,964.78
| Facility | | $331.13 | $331.13 | $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
- $1,659.59 / $1,659.59 / $5,888.44
| Facility | | $1,659.59 | $1,659.59 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,659.59 / $8,709.64
| Professional | | $1,380.38 | $1,659.59 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,187.76 / $4,365.16
| Facility | | $263.03 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,951.21 / $5,011.87
| Professional | | $2,041.74 | $2,951.21 | $5,011.87 |