- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,951.21 / $5,495.41
| Facility | | $2,290.87 | $2,951.21 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,019.95 / $5,128.61
| Professional | | $2,238.72 | $3,019.95 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,235.94 / $12,882.50
| Facility | | $2,398.83 | $3,235.94 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,162.28 / $6,918.31
| Professional | | $3,019.95 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $22,908.68
| Facility | | $3,981.07 | $3,981.07 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $8,912.51
| Professional | | $2,884.03 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,073.80 / $7,079.46
| Facility | | $3,467.37 | $4,073.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,818.38 / $4,365.16
| Professional | | $2,041.74 | $2,818.38 | $4,365.16 |