- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.64 / $3,498.38 / $6,841.80
| Facility | | $2,064.64 | $3,498.38 | $6,841.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.15 / $2,033.27 / $2,359.60
| Professional | | $1,757.15 | $2,033.27 | $2,359.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $2,510.21 / $9,789.82
| Facility | | $760.00 | $2,510.21 | $9,789.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $376.96 / $1,656.73
| Professional | | $304.00 | $376.96 | $1,656.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.17 / $3,893.62 / $7,704.71
| Facility | | $1,794.17 | $3,893.62 | $7,704.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,776.14 / $3,012.25 / $3,326.13
| Professional | | $2,776.14 | $3,012.25 | $3,326.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.19 / $2,259.19 / $2,259.19
| Facility | | $2,259.19 | $2,259.19 | $2,259.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,506.13 / $2,886.74
| Professional | | $1,054.29 | $1,506.13 | $2,886.74 |