- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.24 / $2,041.60 / $2,431.79
| Professional | | $1,507.24 | $2,041.60 | $2,431.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.07 / $1,964.11 / $3,123.62
| Professional | | $1,419.07 | $1,964.11 | $3,123.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,045.95 / $2,514.14 / $3,399.53
| Professional | | $2,045.95 | $2,514.14 | $3,399.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.69 / $2,356.44 / $3,543.38
| Professional | | $1,449.69 | $2,356.44 | $3,543.38 |