- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,025.55 / $7,993.64 / $20,846.20
| Facility | | $4,025.55 | $7,993.64 | $20,846.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,474.36 / $4,336.42 / $4,440.91
| Professional | | $3,474.36 | $4,336.42 | $4,440.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.65 / $13,674.20 / $21,661.85
| Facility | | $3,600.65 | $13,674.20 | $21,661.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,428.12 / $4,986.35 / $24,152.68
| Professional | | $3,428.12 | $4,986.35 | $24,152.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,868.00 / $8,150.38 / $14,602.76
| Facility | | $2,868.00 | $8,150.38 | $14,602.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.48 / $5,224.60 / $9,946.16
| Facility | | $3,500.48 | $5,224.60 | $9,946.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $2,194.33 / $26,018.51
| Professional | | $2,194.33 | $2,194.33 | $26,018.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $2,194.33 / $3,134.76
| Professional | | $2,194.33 | $2,194.33 | $3,134.76 |