- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.91 / $5,154.72 / $9,010.70
| Facility | | $1,860.91 | $5,154.72 | $9,010.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.14 / $1,860.91 / $2,326.13
| Professional | | $1,469.14 | $1,860.91 | $2,326.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,134.16 / $7,051.85 / $11,815.28
| Facility | | $3,134.16 | $7,051.85 | $11,815.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.39 / $1,028.39 / $2,448.56
| Professional | | $1,028.39 | $1,028.39 | $2,448.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.57 / $1,639.31 / $7,480.33
| Facility | | $1,400.57 | $1,639.31 | $7,480.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,998.87 / $2,998.87 / $3,550.41
| Professional | | $2,998.87 | $2,998.87 | $3,550.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.91 / $2,448.56 / $3,427.98
| Facility | | $1,860.91 | $2,448.56 | $3,427.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,958.85 / $3,427.98 / $4,897.12
| Professional | | $1,958.85 | $3,427.98 | $4,897.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,028.40 / $1,469.14
| Professional | | $1,028.40 | $1,028.40 | $1,469.14 |