- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,508.76 / $4,058.29 / $10,985.50
| Facility | | $2,508.76 | $4,058.29 | $10,985.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $1,844.68 / $2,064.94
| Professional | | $455.43 | $1,844.68 | $2,064.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.67 / $4,548.39 / $7,205.28
| Facility | | $1,197.67 | $4,548.39 | $7,205.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.76 / $1,935.65 / $9,375.79
| Professional | | $1,330.76 | $1,935.65 | $9,375.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,839.14 / $4,474.03 / $8,053.25
| Facility | | $1,839.14 | $4,474.03 | $8,053.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.68 / $2,753.25 / $5,027.06
| Facility | | $1,844.68 | $2,753.25 | $5,027.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,156.36 / $13,711.19
| Professional | | $1,156.36 | $1,156.36 | $13,711.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,156.36 / $1,651.95
| Professional | | $1,156.36 | $1,156.36 | $1,651.95 |