- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.60 / $4,241.38 / $8,724.79
| Facility | | $2,648.60 | $4,241.38 | $8,724.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,072.14 / $2,523.96 / $3,481.19
| Professional | | $2,072.14 | $2,523.96 | $3,481.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,896.32 / $3,404.23 / $10,060.00
| Facility | | $2,896.32 | $3,404.23 | $10,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.40 / $1,308.72 / $3,489.92
| Professional | | $1,246.40 | $1,308.72 | $3,489.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,531.75 / $5,347.06 / $9,561.27
| Facility | | $2,531.75 | $5,347.06 | $9,561.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.25 / $3,327.81 / $5,700.98
| Professional | | $1,659.25 | $3,327.81 | $5,700.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,964.58 / $2,964.58 / $2,964.58
| Facility | | $2,964.58 | $2,964.58 | $2,964.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.72 / $1,869.60 / $3,739.20
| Professional | | $1,308.72 | $1,869.60 | $3,739.20 |