- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,445.65 / $4,747.68 / $8,134.40
| Facility | | $3,445.65 | $4,747.68 | $8,134.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,378.19 / $2,378.19 / $2,870.13
| Professional | | $2,378.19 | $2,378.19 | $2,870.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.58 / $1,229.58 / $3,927.11
| Professional | | $1,229.58 | $1,229.58 | $3,927.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $6,324.83 / $11,104.07
| Facility | | $3,873.00 | $6,324.83 | $11,104.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.48 / $2,566.87 / $2,566.87
| Professional | | $1,189.48 | $2,566.87 | $2,566.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,196.09 / $6,453.29 / $7,164.64
| Facility | | $6,196.09 | $6,453.29 | $7,164.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.48 / $1,423.58 / $3,543.49
| Professional | | $67.48 | $1,423.58 | $3,543.49 |