- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,213.16 / $6,033.06 / $9,322.28
| Facility | | $3,213.16 | $6,033.06 | $9,322.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,189.69 / $2,540.05 / $3,123.97
| Professional | | $2,189.69 | $2,540.05 | $3,123.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,649.50 / $3,649.50 / $3,649.50
| Professional | | $3,649.50 | $3,649.50 | $3,649.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,580.92 / $4,782.30 / $6,620.47
| Facility | | $2,580.92 | $4,782.30 | $6,620.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,335.67 / $2,919.60 / $3,927.77
| Facility | | $2,335.67 | $2,919.60 | $3,927.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $14,539.61
| Professional | | $1,226.23 | $1,751.76 | $14,539.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $4,379.39
| Professional | | $1,226.23 | $1,751.76 | $4,379.39 |