- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.92 / $1,572.18 / $1,837.43
| Professional | | $1,118.92 | $1,572.18 | $1,837.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.47 / $1,469.17 / $2,326.48
| Professional | | $1,061.47 | $1,469.17 | $2,326.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.38 / $1,946.75 / $2,501.96
| Professional | | $1,530.38 | $1,946.75 | $2,501.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.91 / $1,724.18 / $2,639.11
| Professional | | $1,071.91 | $1,724.18 | $2,639.11 |