- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,011.87 / $13,182.57
| Facility | | $2,398.83 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $3,388.44
| Professional | | $1,905.46 | $2,344.23 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,897.79 / $14,125.38
| Facility | | $2,089.30 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $229.09 / $3,890.45
| Professional | | $208.93 | $229.09 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,677.35 / $11,748.98
| Facility | | $1,905.46 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,265.80 / $7,943.28
| Professional | | $3,388.44 | $4,265.80 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $3,467.37
| Facility | | $1,737.80 | $2,951.21 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $3,467.37
| Professional | | $1,230.27 | $1,737.80 | $3,467.37 |