- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.82 / $3,459.07 / $12,306.10
| Facility | | $2,660.82 | $3,459.07 | $12,306.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.13 / $2,987.15 / $4,593.68
| Professional | | $1,506.13 | $2,987.15 | $4,593.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,088.81 / $5,319.13 / $9,584.31
| Facility | | $3,088.81 | $5,319.13 | $9,584.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.70 / $3,563.87 / $4,462.59
| Professional | | $657.70 | $3,563.87 | $4,462.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,510.21 / $2,510.21
| Facility | | $2,510.21 | $2,510.21 | $2,510.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.81 / $4,815.59 / $17,730.07
| Facility | | $2,626.81 | $4,815.59 | $17,730.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.51 / $2,888.64 / $5,411.26
| Professional | | $1,094.51 | $2,888.64 | $5,411.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,506.13 / $4,338.63
| Professional | | $1,054.29 | $1,506.13 | $4,338.63 |