- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,623.41 / $10,715.19
| Facility | | $3,890.45 | $5,623.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,090.30 / $6,918.31
| Professional | | $2,089.30 | $3,090.30 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $10,471.29
| Facility | | $3,715.35 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,890.45 / $8,709.64
| Professional | | $1,737.80 | $3,890.45 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,466.84 / $14,125.38
| Facility | | $2,511.89 | $4,466.84 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,168.69 / $7,943.28
| Professional | | $2,137.96 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,128.61 / $6,025.60
| Professional | | $3,801.89 | $5,128.61 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,344.23 / $6,760.83
| Professional | | $1,862.09 | $2,344.23 | $6,760.83 |