- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,370.32 / $9,549.93
| Facility | | $3,388.44 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $4,570.88
| Professional | | $2,137.96 | $2,630.27 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,801.89 / $7,244.36
| Facility | | $1,479.11 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,715.35 / $5,128.61
| Professional | | $2,238.72 | $3,715.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,801.89 / $6,025.60
| Professional | | $2,630.27 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,630.27 / $5,011.87
| Professional | | $2,238.72 | $2,630.27 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,235.94 / $8,128.31
| Facility | | $1,047.13 | $3,235.94 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $5,888.44
| Professional | | $2,344.23 | $3,311.31 | $5,888.44 |