- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.28 / $3,590.18 / $13,086.40
| Facility | | $2,637.28 | $3,590.18 | $13,086.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,866.00 / $2,761.68 / $3,234.40
| Professional | | $1,866.00 | $2,761.68 | $3,234.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,694.01 / $4,858.82 / $7,656.07
| Facility | | $2,694.01 | $4,858.82 | $7,656.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $46.62 / $57.00
| Professional | | $3.93 | $46.62 | $57.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,603.28 / $4,772.75 / $17,572.11
| Facility | | $2,603.28 | $4,772.75 | $17,572.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.64 / $2,859.20 / $3,574.00
| Professional | | $1,318.64 | $2,859.20 | $3,574.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.20 / $1,244.00 / $3,732.00
| Professional | | $995.20 | $1,244.00 | $3,732.00 |