- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,354.21 / $4,059.59 / $8,038.80
| Facility | | $2,354.21 | $4,059.59 | $8,038.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,914.10 / $2,325.51 / $3,207.49
| Professional | | $1,914.10 | $2,325.51 | $3,207.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,656.68 / $3,057.61 / $9,269.02
| Facility | | $2,656.68 | $3,057.61 | $9,269.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,205.82 / $3,215.52
| Professional | | $1,148.40 | $1,205.82 | $3,215.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.69 / $4,880.70 / $8,646.39
| Facility | | $2,332.69 | $4,880.70 | $8,646.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.56 / $2,977.26 / $5,172.78
| Professional | | $1,468.56 | $2,977.26 | $5,172.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,727.45 / $2,727.45 / $3,445.20
| Facility | | $2,727.45 | $2,727.45 | $3,445.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.39 / $1,435.50 / $3,158.10
| Professional | | $1,063.39 | $1,435.50 | $3,158.10 |