- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,473.60 / $2,598.69 / $3,138.73
| Facility | | $2,473.60 | $2,598.69 | $3,138.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.89 / $2,666.26 / $3,708.90
| Professional | | $2,043.89 | $2,666.26 | $3,708.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,576.82 / $5,660.55 / $9,938.11
| Facility | | $4,576.82 | $5,660.55 | $9,938.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,748.86 / $2,796.11 / $3,981.97
| Professional | | $2,748.86 | $2,796.11 | $3,981.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.34 / $3,532.34 / $3,532.34
| Facility | | $3,532.34 | $3,532.34 | $3,532.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.61 / $3,456.43 / $3,638.31
| Professional | | $2,578.61 | $3,456.43 | $3,638.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,050.06 / $3,050.06 / $3,050.06
| Facility | | $3,050.06 | $3,050.06 | $3,050.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,902.77 / $2,455.44 / $3,645.88
| Professional | | $1,902.77 | $2,455.44 | $3,645.88 |