- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,263.67 / $2,963.72 / $3,082.27
| Facility | | $2,263.67 | $2,963.72 | $3,082.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,646.09 / $3,212.29 / $3,597.76
| Professional | | $2,646.09 | $3,212.29 | $3,597.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,876.62 / $6,227.51 / $6,545.11
| Facility | | $3,876.62 | $6,227.51 | $6,545.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,912.74 / $3,740.27 / $3,804.46
| Professional | | $2,912.74 | $3,740.27 | $3,804.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,670.63 / $8,780.79 / $10,799.70
| Facility | | $4,670.63 | $8,780.79 | $10,799.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,916.13 / $7,784.39 / $10,275.39
| Professional | | $5,916.13 | $7,784.39 | $10,275.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,366.38 / $4,366.38 / $8,204.92
| Facility | | $4,366.38 | $4,366.38 | $8,204.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,187.46 / $4,366.38 / $34,389.30
| Professional | | $3,187.46 | $4,366.38 | $34,389.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,254.52 / $3,968.93 / $4,961.16
| Professional | | $3,254.52 | $3,968.93 | $4,961.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.23 / $3,106.84 / $4,763.02
| Professional | | $2,071.23 | $3,106.84 | $4,763.02 |