- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,766.01 / $2,766.01 / $3,319.21
| Facility | | $2,766.01 | $2,766.01 | $3,319.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.89 / $2,146.36 / $3,308.49
| Professional | | $2,043.89 | $2,146.36 | $3,308.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,912.39 / $4,912.39 / $5,823.15
| Facility | | $4,912.39 | $4,912.39 | $5,823.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,796.11 / $2,796.11 / $2,920.66
| Professional | | $2,796.11 | $2,796.11 | $2,920.66 |
- 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 / $2,578.61 / $3,610.56
| Professional | | $2,578.61 | $2,578.61 | $3,610.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,977.34 / $3,977.34 / $12,276.06
| Professional | | $3,977.34 | $3,977.34 | $12,276.06 |
- 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
- $1,633.82 / $2,450.73 / $3,436.07
| Professional | | $1,633.82 | $2,450.73 | $3,436.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,679.23 / $4,047.15 / $5,150.92
| Professional | | $3,679.23 | $4,047.15 | $5,150.92 |