- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $7,762.47
| Facility | | $2,137.96 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,344.23 / $6,309.57
| Professional | | $2,089.30 | $2,344.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,715.35 / $10,715.19
| Professional | | $2,511.89 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,467.37 / $6,309.57
| Professional | | $2,238.72 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,677.35 / $5,248.07
| Professional | | $2,089.30 | $4,677.35 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,218.10 / $33,884.42
| Facility | | $4,073.80 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,090.30 / $6,309.57
| Professional | | $1,862.09 | $3,090.30 | $6,309.57 |