- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.71 / $3,657.79 / $4,856.78
| Facility | | $2,060.71 | $3,657.79 | $4,856.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.22 / $1,717.27 / $2,531.87
| Professional | | $1,651.22 | $1,717.27 | $2,531.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.53 / $2,201.62 / $5,283.89
| Facility | | $715.53 | $2,201.62 | $5,283.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.34 / $1,140.43 / $1,615.98
| Professional | | $12.34 | $1,140.43 | $1,615.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,431.05 / $2,575.89 / $3,577.63
| Facility | | $1,431.05 | $2,575.89 | $3,577.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.63 / $2,529.63 / $3,162.03
| Professional | | $2,529.63 | $2,529.63 | $3,162.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,201.62 / $2,201.62 / $2,311.69
| Professional | | $2,201.62 | $2,201.62 | $2,311.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.43 / $3,302.43 / $3,302.43
| Facility | | $3,302.43 | $3,302.43 | $3,302.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.68 / $924.68 / $2,201.62
| Professional | | $924.68 | $924.68 | $2,201.62 |