- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,030.23 / $5,715.37 / $13,749.10
| Facility | | $4,030.23 | $5,715.37 | $13,749.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,387.78 / $5,510.33 / $7,804.02
| Professional | | $3,387.78 | $5,510.33 | $7,804.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.29 / $5,225.22 / $10,826.06
| Facility | | $3,276.29 | $5,225.22 | $10,826.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,863.82 / $4,900.85 / $6,494.68
| Professional | | $2,863.82 | $4,900.85 | $6,494.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,256.46 / $2,356.36 / $4,504.16
| Facility | | $2,256.46 | $2,356.36 | $4,504.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,314.60 / $8,314.60 / $8,314.60
| Professional | | $8,314.60 | $8,314.60 | $8,314.60 |