- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,162.28 / $7,762.47
| Facility | | $1,698.24 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,951.21 / $4,466.84
| Professional | | $2,454.71 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $3,801.89
| Professional | | $2,511.89 | $2,951.21 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,090.30 / $7,585.78
| Professional | | $2,290.87 | $3,090.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,754.23 / $6,025.60
| Professional | | $2,630.27 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $6,309.57
| Facility | | $645.65 | $2,344.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $6,606.93
| Professional | | $2,137.96 | $2,951.21 | $6,606.93 |