- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,022.04 / $4,285.63 / $10,309.67
| Facility | | $3,022.04 | $4,285.63 | $10,309.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,540.30 / $4,131.89 / $5,851.79
| Professional | | $2,540.30 | $4,131.89 | $5,851.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,456.69 / $3,918.10 / $8,117.85
| Facility | | $2,456.69 | $3,918.10 | $8,117.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.42 / $3,674.87 / $4,869.99
| Professional | | $2,147.42 | $3,674.87 | $4,869.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.78 / $1,630.23 / $2,829.23
| Facility | | $1,519.78 | $1,630.23 | $2,829.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,064.84 / $8,064.84 / $8,064.84
| Professional | | $8,064.84 | $8,064.84 | $8,064.84 |