- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,951.21 / $6,606.93
| Facility | | $1,288.25 | $2,951.21 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $4,786.30
| Professional | | $2,511.89 | $2,884.03 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $3,630.78
| Professional | | $2,630.27 | $3,311.31 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $4,570.88
| Professional | | $1,905.46 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,090.30 / $5,888.44
| Facility | | $1,096.48 | $3,090.30 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $20,417.38
| Professional | | $2,398.83 | $3,162.28 | $20,417.38 |
- 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
- $2,290.87 / $2,884.03 / $4,168.69
| Professional | | $2,290.87 | $2,884.03 | $4,168.69 |