- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.13 / $3,715.22 / $13,542.10
| Facility | | $2,729.13 | $3,715.22 | $13,542.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.79 / $3,063.83 / $3,347.05
| Professional | | $1,544.79 | $3,063.83 | $3,347.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,787.83 / $5,028.03 / $7,922.71
| Facility | | $2,787.83 | $5,028.03 | $7,922.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.69 / $986.55 / $1,095.07
| Professional | | $902.69 | $986.55 | $1,095.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,574.65 / $2,574.65 / $2,574.65
| Facility | | $2,574.65 | $2,574.65 | $2,574.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,673.52 / $2,073.48 / $19,548.25
| Facility | | $1,673.52 | $2,073.48 | $19,548.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.34 / $1,544.79 / $3,604.51
| Professional | | $1,081.34 | $1,544.79 | $3,604.51 |