- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.05 / $5,588.74 / $11,803.40
| Facility | | $3,292.05 | $5,588.74 | $11,803.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $3,137.13 / $3,640.62
| Professional | | $2,711.10 | $3,137.13 | $3,640.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,583.88 / $4,182.84 / $11,709.24
| Facility | | $3,583.88 | $4,182.84 | $11,709.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.40 / $1,246.40 / $4,279.66
| Professional | | $1,246.40 | $1,246.40 | $4,279.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,675.48 / $6,545.37 / $11,253.00
| Facility | | $3,675.48 | $6,545.37 | $11,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $4,717.52 / $5,652.12
| Professional | | $3,873.00 | $4,717.52 | $5,652.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.15 / $2,130.15 / $3,873.00
| Facility | | $2,130.15 | $2,130.15 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $4,647.60
| Professional | | $1,626.66 | $2,323.80 | $4,647.60 |