- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,370.32 / $13,489.63
| Facility | | $2,570.40 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $2,511.89 / $4,786.30
| Professional | | $323.59 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,981.07 / $13,489.63
| Facility | | $2,754.23 | $3,981.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $4,570.88
| Professional | | $794.33 | $1,258.93 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $13,182.57
| Facility | | $2,041.74 | $6,025.60 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $7,585.78
| Professional | | $1,548.82 | $3,801.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,090.30 / $3,715.35
| Facility | | $1,862.09 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $3,715.35
| Professional | | $1,318.26 | $1,862.09 | $3,715.35 |