- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,213.16 / $6,350.13 / $10,896.80
| Facility | | $3,213.16 | $6,350.13 | $10,896.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.67 / $2,540.05 / $3,123.97
| Professional | | $2,335.67 | $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
- $2,846.03 / $6,377.96 / $7,086.63
| Facility | | $2,846.03 | $6,377.96 | $7,086.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,540.05 / $2,919.60 / $3,927.77
| Facility | | $2,540.05 | $2,919.60 | $3,927.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $5,955.98
| Professional | | $1,226.23 | $1,751.76 | $5,955.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $4,671.35
| Professional | | $1,226.23 | $1,751.76 | $4,671.35 |