- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,630.27 / $8,511.38
| Facility | | $2,570.40 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,570.40 / $6,165.95
| Professional | | $2,398.83 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,754.40 / $6,760.83
| Professional | | $4,677.35 | $5,754.40 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,897.79 / $7,943.28
| Professional | | $3,090.30 | $4,897.79 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,235.94 / $5,495.41
| Facility | | $2,630.27 | $3,235.94 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,677.35 / $19,054.61
| Professional | | $2,754.23 | $4,677.35 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $14,125.38
| Facility | | $1,819.70 | $2,041.74 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,677.35 / $6,309.57
| Professional | | $2,754.23 | $4,677.35 | $6,309.57 |