- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,862.09 / $8,511.38
| Facility | | $1,778.28 | $1,862.09 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,862.09 / $2,754.23
| Professional | | $1,659.59 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,365.16 / $5,128.61
| Professional | | $3,467.37 | $4,365.16 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,388.44 / $6,025.60
| Professional | | $2,511.89 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,754.23 / $5,623.41
| Facility | | $1,862.09 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,388.44 / $3,981.07
| Professional | | $1,737.80 | $3,388.44 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,388.44 / $4,466.84
| Professional | | $1,737.80 | $3,388.44 | $4,466.84 |