- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,677.35 / $8,317.64
| Facility | | $2,089.30 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,137.96 / $2,951.21
| Professional | | $1,621.81 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,318.26 / $1,995.26
| Facility | | $416.87 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $851.14 / $3,981.07
| Professional | | $177.83 | $851.14 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,818.38 / $5,011.87
| Facility | | $218.78 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,019.95 / $5,888.44
| Professional | | $2,344.23 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,235.94 / $5,370.32
| Facility | | $2,137.96 | $3,235.94 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $4,897.79
| Professional | | $2,290.87 | $2,818.38 | $4,897.79 |