- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,890.45 / $7,943.28
| Facility | | $2,041.74 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,162.28 / $7,079.46
| Professional | | $2,691.53 | $3,162.28 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,365.16 / $7,943.28
| Facility | | $1,659.59 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $6,309.57
| Professional | | $3,090.30 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,311.31 / $6,025.60
| Professional | | $2,187.76 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,162.28 / $5,754.40
| Facility | | $1,737.80 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,630.78 / $21,877.62
| Professional | | $2,511.89 | $3,630.78 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,137.96 / $5,248.07
| Facility | | $831.76 | $2,137.96 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,090.30 / $5,495.41
| Professional | | $2,398.83 | $3,090.30 | $5,495.41 |