- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,546.50 / $3,679.35 / $8,838.57
| Facility | | $2,546.50 | $3,679.35 | $8,838.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,052.69 / $2,546.50 / $2,884.93
| Professional | | $2,052.69 | $2,546.50 | $2,884.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,232.99 / $4,540.32 / $9,333.16
| Facility | | $3,232.99 | $4,540.32 | $9,333.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.23 / $3,670.07 / $7,416.95
| Professional | | $1,975.23 | $3,670.07 | $7,416.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,517.44 / $12,457.04 / $22,229.37
| Facility | | $2,517.44 | $12,457.04 | $22,229.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,317.90 / $4,817.30 / $15,252.16
| Professional | | $2,317.90 | $4,817.30 | $15,252.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $5,158.84 / $7,358.70
| Professional | | $2,711.10 | $5,158.84 | $7,358.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,781.58 / $2,323.80 / $6,796.73
| Professional | | $1,781.58 | $2,323.80 | $6,796.73 |