- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,570.40 / $11,748.98
| Facility | | $2,454.71 | $2,570.40 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $1,949.84
| Professional | | $1,174.90 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $8,912.51
| Facility | | $2,238.72 | $4,265.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,630.27 / $4,168.69
| Professional | | $2,041.74 | $2,630.27 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $10,471.29 / $25,703.96
| Facility | | $134.90 | $10,471.29 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $1,995.26
| Professional | | $1,548.82 | $1,862.09 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,949.84 / $3,981.07
| Facility | | $912.01 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $2,041.74
| Professional | | $776.25 | $1,174.90 | $2,041.74 |