- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,311.31 / $6,606.93
| Facility | | $1,288.25 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $5,128.61
| Professional | | $2,630.27 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,981.07 / $5,011.87
| Professional | | $2,951.21 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,630.78 / $5,128.61
| Professional | | $1,737.80 | $3,630.78 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,388.44 / $5,888.44
| Facility | | $1,096.48 | $3,388.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,467.37 / $21,877.62
| Professional | | $2,511.89 | $3,467.37 | $21,877.62 |
- 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
- $2,398.83 / $3,162.28 / $4,677.35
| Professional | | $2,398.83 | $3,162.28 | $4,677.35 |