- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.56 / $2,500.09 / $2,600.09
| Facility | | $1,909.56 | $2,500.09 | $2,600.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,232.15 / $2,901.10 / $3,249.23
| Professional | | $2,232.15 | $2,901.10 | $3,249.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,270.19 / $5,253.31 / $5,521.23
| Facility | | $3,270.19 | $5,253.31 | $5,521.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,457.08 / $3,155.15 / $3,194.59
| Professional | | $2,457.08 | $3,155.15 | $3,194.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,939.98 / $7,407.17 / $9,753.49
| Facility | | $3,939.98 | $7,407.17 | $9,753.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,181.54 / $7,010.32 / $8,667.95
| Professional | | $5,181.54 | $7,010.32 | $8,667.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,943.38 / $3,943.38 / $6,811.37
| Facility | | $3,943.38 | $3,943.38 | $6,811.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,878.67 / $3,943.38 / $28,548.52
| Professional | | $2,878.67 | $3,943.38 | $28,548.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,745.39 / $3,348.04 / $4,185.05
| Professional | | $2,745.39 | $3,348.04 | $4,185.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,747.21 / $2,708.31 / $4,018.11
| Professional | | $1,747.21 | $2,708.31 | $4,018.11 |