- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,818.38 / $7,762.47
| Facility | | $1,698.24 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,818.38 / $6,760.83
| Professional | | $1,513.56 | $2,818.38 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $3,548.13
| Professional | | $2,884.03 | $3,388.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,019.95 / $5,888.44
| Professional | | $2,041.74 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $5,011.87
| Professional | | $4,677.35 | $4,677.35 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $16,218.10
| Facility | | $645.65 | $2,344.23 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,162.28 / $6,456.54
| Professional | | $1,949.84 | $3,162.28 | $6,456.54 |