- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,865.56 / $4,661.34 / $12,895.02
| Facility | | $2,865.56 | $4,661.34 | $12,895.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.98 / $2,321.98 / $2,321.98
| Professional | | $2,321.98 | $2,321.98 | $2,321.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.65 / $1,388.31 / $1,846.45
| Professional | | $1,302.65 | $1,388.31 | $1,846.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $6,992.94 / $11,104.07
| Facility | | $3,873.00 | $6,992.94 | $11,104.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.72 / $2,836.57 / $2,836.57
| Professional | | $1,314.72 | $2,836.57 | $2,836.57 |
- 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
- $785.69 / $2,357.37 / $4,000.93
| Professional | | $785.69 | $2,357.37 | $4,000.93 |