- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,007.82 / $3,085.19 / $6,812.38
| Facility | | $2,007.82 | $3,085.19 | $6,812.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.99 / $2,007.82 / $2,528.59
| Professional | | $1,713.99 | $2,007.82 | $2,528.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.46 / $2,658.94 / $8,472.02
| Facility | | $2,369.46 | $2,658.94 | $8,472.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.42 / $1,273.24 / $2,938.27
| Professional | | $979.42 | $1,273.24 | $2,938.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,092.90 / $4,138.06 / $7,162.02
| Facility | | $2,092.90 | $4,138.06 | $7,162.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,155.76 / $2,256.69 / $4,170.39
| Professional | | $1,155.76 | $2,256.69 | $4,170.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.14 / $2,326.12 / $2,938.27
| Facility | | $1,469.14 | $2,326.12 | $2,938.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,469.14 / $2,742.39
| Professional | | $1,028.40 | $1,469.14 | $2,742.39 |