- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.86 / $4,656.97 / $12,606.10
| Facility | | $2,878.86 | $4,656.97 | $12,606.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $2,101.01 / $2,685.51
| Professional | | $477.00 | $2,101.01 | $2,685.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,177.38 / $8,269.04 / $13,099.34
| Facility | | $2,177.38 | $8,269.04 | $13,099.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.05 / $3,015.35 / $14,605.61
| Professional | | $2,073.05 | $3,015.35 | $14,605.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.46 / $5,134.05 / $9,241.29
| Facility | | $2,110.46 | $5,134.05 | $9,241.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.81 / $3,159.42 / $5,768.59
| Facility | | $2,116.81 | $3,159.42 | $5,768.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,326.96 / $15,733.91
| Professional | | $1,326.96 | $1,326.96 | $15,733.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,326.96 / $1,895.65
| Professional | | $1,326.96 | $1,326.96 | $1,895.65 |