- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,128.61 / $10,232.93
| Facility | | $2,691.53 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,238.72 / $2,754.23
| Professional | | $457.09 | $2,238.72 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,011.87 / $6,309.57
| Facility | | $2,511.89 | $5,011.87 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $3,715.35
| Facility | | $2,187.76 | $2,754.23 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $13,803.84
| Professional | | $1,148.15 | $1,659.59 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,754.23 / $3,311.31
| Facility | | $1,148.15 | $2,754.23 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $3,548.13
| Professional | | $1,148.15 | $1,659.59 | $3,548.13 |