- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,888.44 / $15,848.93
| Facility | | $2,884.03 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,754.23 / $3,981.07
| Professional | | $2,238.72 | $2,754.23 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,754.40 / $16,595.87
| Facility | | $2,511.89 | $5,754.40 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $380.19 / $3,715.35
| Professional | | $323.59 | $380.19 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,495.41 / $13,803.84
| Facility | | $2,238.72 | $5,495.41 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,011.87 / $9,549.93
| Professional | | $3,981.07 | $5,011.87 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $4,168.69
| Facility | | $1,445.44 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,041.74 / $4,168.69
| Professional | | $1,445.44 | $2,041.74 | $4,168.69 |