- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,818.38 / $6,606.93
| Facility | | $933.25 | $2,818.38 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,691.53 / $3,630.78
| Professional | | $2,089.30 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,786.30 / $7,079.46
| Facility | | $2,818.38 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,884.03 / $3,162.28
| Professional | | $2,570.40 | $2,884.03 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $4,466.84
| Professional | | $1,949.84 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $8,511.38
| Facility | | $1,023.29 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $4,168.69
| Professional | | $2,238.72 | $2,691.53 | $4,168.69 |