- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,228.30 / $3,765.31 / $7,028.59
| Facility | | $2,228.30 | $3,765.31 | $7,028.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,882.66 / $2,058.37 / $2,886.74
| Professional | | $1,882.66 | $2,058.37 | $2,886.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.70 / $3,099.02 / $8,685.33
| Facility | | $2,376.70 | $3,099.02 | $8,685.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.60 / $1,506.12 / $3,294.26
| Professional | | $1,239.60 | $1,506.12 | $3,294.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,145.61 / $4,307.53 / $7,402.72
| Facility | | $2,145.61 | $4,307.53 | $7,402.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.00 / $2,884.39 / $4,735.42
| Professional | | $1,478.00 | $2,884.39 | $4,735.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,510.21 / $3,137.76
| Facility | | $2,510.21 | $2,510.21 | $3,137.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,506.13 / $3,417.12
| Professional | | $1,054.29 | $1,506.13 | $3,417.12 |