- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,370.32 / $7,943.28
| Facility | | $2,570.40 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,737.80 / $3,388.44
| Professional | | $1,445.44 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,801.89 / $6,918.31
| Facility | | $1,412.54 | $3,801.89 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $3,548.13
| Professional | | $1,621.81 | $2,511.89 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,511.89 / $2,630.27
| Facility | | $501.19 | $2,511.89 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,454.71 / $4,073.80
| Professional | | $1,659.59 | $2,454.71 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $8,912.51
| Professional | | $1,621.81 | $2,344.23 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,918.31 / $12,022.64
| Facility | | $1,737.80 | $6,918.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $3,467.37
| Professional | | $1,380.38 | $2,137.96 | $3,467.37 |