- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $7,762.47
| Facility | | $2,089.30 | $2,951.21 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,238.72 / $9,332.54
| Professional | | $1,862.09 | $2,238.72 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $3,548.13
| Professional | | $2,137.96 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,754.23
| Professional | | $32.36 | $33.11 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,754.23 / $7,244.36
| Facility | | $2,511.89 | $2,754.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $3,548.13
| Professional | | $2,137.96 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $19,498.45
| Facility | | $3,090.30 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $4,073.80
| Professional | | $2,238.72 | $2,818.38 | $4,073.80 |