- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,030.09 / $5,689.32 / $8,791.12
| Facility | | $3,030.09 | $5,689.32 | $8,791.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,064.94 / $2,395.33 / $2,945.98
| Professional | | $2,064.94 | $2,395.33 | $2,945.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,441.56 / $3,441.56 / $3,441.56
| Professional | | $3,441.56 | $3,441.56 | $3,441.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,433.87 / $4,509.82 / $6,243.19
| Facility | | $2,433.87 | $4,509.82 | $6,243.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.60 / $2,753.25 / $3,703.98
| Facility | | $2,202.60 | $2,753.25 | $3,703.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,651.95 / $13,711.19
| Professional | | $1,156.36 | $1,651.95 | $13,711.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,651.95 / $4,129.88
| Professional | | $1,156.36 | $1,651.95 | $4,129.88 |