- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.82 / $3,622.23 / $13,203.20
| Facility | | $2,660.82 | $3,622.23 | $13,203.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.13 / $2,987.15 / $3,263.27
| Professional | | $1,506.13 | $2,987.15 | $3,263.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,931.92 / $5,084.93 / $8,452.42
| Facility | | $2,931.92 | $5,084.93 | $8,452.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.35 / $1,553.24 / $1,654.57
| Professional | | $1,242.35 | $1,553.24 | $1,654.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,510.21 / $2,510.21
| Facility | | $2,510.21 | $2,510.21 | $2,510.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.81 / $4,815.59 / $17,730.07
| Facility | | $2,626.81 | $4,815.59 | $17,730.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,506.13 / $3,625.86
| Professional | | $1,054.29 | $1,506.13 | $3,625.86 |