- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,456.54 / $11,748.98
| Facility | | $3,090.30 | $6,456.54 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,344.23 / $3,090.30
| Professional | | $478.63 | $2,344.23 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,754.40 / $7,244.36
| Facility | | $2,884.03 | $5,754.40 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,162.28 / $4,265.80
| Facility | | $2,511.89 | $3,162.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $15,848.93
| Professional | | $1,318.26 | $1,905.46 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,162.28 / $3,801.89
| Facility | | $1,318.26 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $4,073.80
| Professional | | $1,318.26 | $1,905.46 | $4,073.80 |