- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.16 / $3,987.44 / $7,957.63
| Facility | | $2,445.16 | $3,987.44 | $7,957.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.72 / $2,394.07 / $2,744.42
| Professional | | $2,043.72 | $2,394.07 | $2,744.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,901.35 / $4,284.51 / $14,088.24
| Facility | | $1,901.35 | $4,284.51 | $14,088.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,226.23 / $2,919.60
| Professional | | $1,167.83 | $1,226.23 | $2,919.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.46 / $4,312.79 / $8,919.37
| Facility | | $2,218.46 | $4,312.79 | $8,919.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,556.09 / $3,556.09 / $4,260.59
| Professional | | $3,556.09 | $3,556.09 | $4,260.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,773.62 / $2,773.62 / $3,503.51
| Facility | | $2,773.62 | $2,773.62 | $3,503.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $3,302.07
| Professional | | $1,226.23 | $1,751.76 | $3,302.07 |