- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,344.23 / $8,511.38
| Facility | | $2,238.72 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,344.23 / $5,754.40
| Professional | | $2,137.96 | $2,344.23 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $6,606.93
| Professional | | $4,466.84 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,365.16 / $7,079.46
| Professional | | $2,454.71 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,090.30 / $4,265.80
| Facility | | $2,344.23 | $3,090.30 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,168.69 / $17,782.79
| Professional | | $2,238.72 | $4,168.69 | $17,782.79 |
- 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
- $2,187.76 / $4,168.69 / $5,888.44
| Professional | | $2,187.76 | $4,168.69 | $5,888.44 |