- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $7,244.36
| Facility | | $3,162.28 | $3,162.28 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $3,090.30
| Professional | | $478.63 | $478.63 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,248.07 / $8,511.38
| Facility | | $3,890.45 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $724.44 / $3,981.07
| Professional | | $446.68 | $724.44 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $10,964.78 / $15,848.93
| Facility | | $2,041.74 | $10,964.78 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,888.44 / $6,918.31
| Professional | | $4,265.80 | $5,888.44 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $5,495.41
| Professional | | $1,513.56 | $1,905.46 | $5,495.41 |