- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,884.03 / $6,606.93
| Facility | | $1,288.25 | $2,884.03 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,570.40 / $3,801.89
| Professional | | $1,995.26 | $2,570.40 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $3,630.78
| Professional | | $2,754.23 | $3,311.31 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $3,801.89
| Professional | | $2,454.71 | $3,467.37 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,884.03 / $6,309.57
| Facility | | $346.74 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,691.53 / $26,302.68
| Professional | | $2,089.30 | $2,691.53 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,454.71 / $3,890.45
| Professional | | $1,949.84 | $2,454.71 | $3,890.45 |