- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $8,508.95
| Facility | | $2,424.15 | $3,706.14 | $8,508.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.21 / $1,264.58 / $1,518.90
| Professional | | $1,113.21 | $1,264.58 | $1,518.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.29 / $1,556.81 / $2,488.65
| Professional | | $1,323.29 | $1,556.81 | $2,488.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.68 / $1,729.43 / $3,117.28
| Professional | | $1,421.68 | $1,729.43 | $3,117.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.09 / $1,893.11 / $3,151.44
| Professional | | $1,259.09 | $1,893.11 | $3,151.44 |