- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.48 / $1,870.17 / $2,400.40
| Facility | | $1,850.48 | $1,870.17 | $2,400.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.27 / $1,944.58 / $2,818.23
| Professional | | $1,556.27 | $1,944.58 | $2,818.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.99 / $4,282.53 / $7,775.34
| Facility | | $3,532.99 | $4,282.53 | $7,775.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,035.69 / $2,063.67 / $3,176.81
| Professional | | $2,035.69 | $2,063.67 | $3,176.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.90 / $2,117.90 / $2,338.34
| Facility | | $2,117.90 | $2,117.90 | $2,338.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.07 / $1,546.07 / $4,002.01
| Professional | | $1,546.07 | $1,546.07 | $4,002.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.52 / $1,774.72 / $2,677.03
| Professional | | $1,455.52 | $1,774.72 | $2,677.03 |