- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,773.62 / $3,045.14 / $8,122.91
| Facility | | $2,773.62 | $3,045.14 | $8,122.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.39 / $1,919.64 / $2,043.72
| Professional | | $1,547.39 | $1,919.64 | $2,043.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.14 / $4,284.51 / $7,226.01
| Facility | | $1,263.14 | $4,284.51 | $7,226.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.64 / $1,751.76 / $3,775.33
| Professional | | $1,265.64 | $1,751.76 | $3,775.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,922.52 / $3,648.61 / $13,281.73
| Facility | | $2,922.52 | $3,648.61 | $13,281.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,357.54 / $5,319.51 / $7,211.41
| Professional | | $3,357.54 | $5,319.51 | $7,211.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.02 / $1,751.76 / $5,123.60
| Professional | | $1,343.02 | $1,751.76 | $5,123.60 |