- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,623.41 / $11,748.98
| Facility | | $3,890.45 | $5,623.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,884.03 / $3,715.35
| Professional | | $2,089.30 | $2,884.03 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,025.60 / $10,471.29
| Facility | | $4,265.80 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,570.40 / $8,511.38
| Professional | | $1,258.93 | $2,570.40 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,248.07 / $14,125.38
| Facility | | $2,511.89 | $5,248.07 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,244.36 / $8,317.64
| Professional | | $5,248.07 | $7,244.36 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,344.23 / $6,760.83
| Professional | | $1,862.09 | $2,344.23 | $6,760.83 |