- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,951.21 / $7,762.47
| Facility | | $1,698.24 | $2,951.21 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,951.21 / $7,413.10
| Professional | | $1,698.24 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,818.38 / $3,801.89
| Professional | | $2,511.89 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,235.94 / $6,165.95
| Professional | | $2,238.72 | $3,235.94 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,248.07 / $5,248.07
| Professional | | $4,897.79 | $5,248.07 | $5,248.07 |
- 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
- $2,290.87 / $3,388.44 / $6,918.31
| Professional | | $2,290.87 | $3,388.44 | $6,918.31 |