- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.97 / $5,260.11 / $13,717.50
| Facility | | $2,648.97 | $5,260.11 | $13,717.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,286.26 / $2,853.53 / $2,922.29
| Professional | | $2,286.26 | $2,853.53 | $2,922.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.36 / $8,998.11 / $14,254.28
| Facility | | $2,369.36 | $8,998.11 | $14,254.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,255.83 / $3,281.21 / $15,893.35
| Professional | | $2,255.83 | $3,281.21 | $15,893.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,887.25 / $2,387.48 / $6,279.48
| Facility | | $1,887.25 | $2,387.48 | $6,279.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.44 / $3,437.98 / $6,745.61
| Facility | | $2,303.44 | $3,437.98 | $6,745.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.95 / $1,443.95 / $17,121.14
| Professional | | $1,443.95 | $1,443.95 | $17,121.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.95 / $1,443.95 / $2,062.79
| Professional | | $1,443.95 | $1,443.95 | $2,062.79 |