- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,524.65 / $3,582.11 / $8,617.25
| Facility | | $2,524.65 | $3,582.11 | $8,617.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.08 / $2,475.29 / $4,314.78
| Professional | | $1,468.08 | $2,475.29 | $4,314.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.71 / $3,274.91 / $6,785.24
| Facility | | $2,278.71 | $3,274.91 | $6,785.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.33 / $2,257.73 / $3,934.42
| Professional | | $1,396.33 | $2,257.73 | $3,934.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.86 / $1,073.86 / $1,986.01
| Facility | | $752.86 | $1,073.86 | $1,986.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.00 / $4,292.00 / $4,714.54
| Professional | | $1,372.00 | $4,292.00 | $4,714.54 |