- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.17 / $2,124.90 / $2,583.11
| Facility | | $2,066.17 | $2,124.90 | $2,583.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.82 / $2,193.33 / $3,146.89
| Professional | | $1,761.82 | $2,193.33 | $3,146.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,856.27 / $4,405.22 / $7,798.88
| Facility | | $3,856.27 | $4,405.22 | $7,798.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,324.80 / $2,335.56 / $3,223.07
| Professional | | $2,324.80 | $2,335.56 | $3,223.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,297.39 / $3,297.39 / $3,297.39
| Facility | | $3,297.39 | $3,297.39 | $3,297.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.09 / $2,542.55 / $3,396.31
| Professional | | $2,407.09 | $2,542.55 | $3,396.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,332.71 / $5,097.31 / $5,097.31
| Facility | | $4,332.71 | $5,097.31 | $5,097.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.37 / $2,109.32 / $3,053.24
| Professional | | $1,589.37 | $2,109.32 | $3,053.24 |