- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.57 / $2,330.10 / $3,004.40
| Facility | | $2,318.57 | $2,330.10 | $3,004.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,933.56 / $2,342.01 / $3,337.72
| Professional | | $1,933.56 | $2,342.01 | $3,337.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,256.76 / $5,123.70 / $8,568.20
| Facility | | $4,256.76 | $5,123.70 | $8,568.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,475.24 / $2,516.48 / $3,786.89
| Professional | | $2,475.24 | $2,516.48 | $3,786.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.97 / $3,364.97 / $3,364.97
| Facility | | $3,364.97 | $3,364.97 | $3,364.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,456.42 / $2,979.98 / $3,587.23
| Professional | | $2,456.42 | $2,979.98 | $3,587.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.28 / $2,298.11 / $3,336.30
| Professional | | $1,691.28 | $2,298.11 | $3,336.30 |