- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,844.93 / $4,512.35 / $9,370.53
| Facility | | $2,844.93 | $4,512.35 | $9,370.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,406.59 / $2,819.15 / $3,094.19
| Professional | | $2,406.59 | $2,819.15 | $3,094.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.33 / $5,045.24 / $13,408.12
| Facility | | $1,117.33 | $5,045.24 | $13,408.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.33 / $390.39 / $2,234.67
| Professional | | $325.33 | $390.39 | $2,234.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,865.99 / $4,654.86 / $10,187.79
| Facility | | $2,865.99 | $4,654.86 | $10,187.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,187.37 / $4,187.37 / $5,016.93
| Professional | | $4,187.37 | $4,187.37 | $5,016.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,266.08 / $3,437.98 / $4,641.27
| Facility | | $3,266.08 | $3,437.98 | $4,641.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.95 / $2,062.79 / $3,953.68
| Professional | | $1,443.95 | $2,062.79 | $3,953.68 |