- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.13 / $3,297.53 / $6,038.88
| Facility | | $2,003.13 | $3,297.53 | $6,038.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.85 / $1,758.68 / $1,912.56
| Professional | | $1,538.85 | $1,758.68 | $1,912.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.46 / $3,226.08 / $8,573.57
| Facility | | $714.46 | $3,226.08 | $8,573.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $597.16 / $2,198.35
| Professional | | $514.79 | $597.16 | $2,198.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,571.27 / $3,409.99 / $6,747.16
| Facility | | $1,571.27 | $3,409.99 | $6,747.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,677.46 / $2,677.46 / $3,207.90
| Professional | | $2,677.46 | $2,677.46 | $3,207.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,978.52 / $1,978.52 / $1,978.52
| Facility | | $1,978.52 | $1,978.52 | $1,978.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.31 / $1,319.01 / $2,528.10
| Professional | | $923.31 | $1,319.01 | $2,528.10 |