- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,290.87 / $8,511.38
| Facility | | $2,238.72 | $2,290.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,238.72 / $5,370.32
| Professional | | $2,041.74 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,011.87 / $5,888.44
| Professional | | $4,073.80 | $5,011.87 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,265.80 / $7,079.46
| Professional | | $2,511.89 | $4,265.80 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,019.95 / $4,786.30
| Facility | | $2,290.87 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,073.80 / $21,379.62
| Professional | | $2,398.83 | $4,073.80 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $11,481.54
| Facility | | $1,819.70 | $2,041.74 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,073.80 / $5,623.41
| Professional | | $2,398.83 | $4,073.80 | $5,623.41 |