- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,077.32 / $3,159.42 / $7,210.11
| Facility | | $2,077.32 | $3,159.42 | $7,210.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.49 / $2,077.32 / $2,211.59
| Professional | | $1,674.49 | $2,077.32 | $2,211.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.66 / $3,232.03 / $7,508.48
| Facility | | $2,043.66 | $3,232.03 | $7,508.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.73 / $2,353.76 / $3,858.91
| Professional | | $1,421.73 | $2,353.76 | $3,858.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,053.62 / $10,161.87 / $18,134.18
| Facility | | $2,053.62 | $10,161.87 | $18,134.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,633.33 / $5,756.46 / $7,803.77
| Professional | | $3,633.33 | $5,756.46 | $7,803.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.33 / $1,895.65 / $5,544.47
| Professional | | $1,453.33 | $1,895.65 | $5,544.47 |