- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,934.37 / $2,514.67 / $8,946.31
| Facility | | $1,934.37 | $2,514.67 | $8,946.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.93 / $2,208.10 / $2,838.69
| Professional | | $1,094.93 | $2,208.10 | $2,838.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,246.06 / $4,012.18 / $7,334.08
| Facility | | $2,246.06 | $4,012.18 | $7,334.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $1,864.40 / $3,204.97
| Professional | | $846.27 | $1,864.40 | $3,204.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $1,824.88
| Facility | | $1,824.88 | $1,824.88 | $1,824.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.45 / $5,053.38 / $11,270.39
| Facility | | $1,909.45 | $5,053.38 | $11,270.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.18 / $1,562.00 / $3,933.81
| Professional | | $853.18 | $1,562.00 | $3,933.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.45 / $1,094.93 / $3,264.71
| Professional | | $766.45 | $1,094.93 | $3,264.71 |