- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $16,982.44
| Facility | | $2,041.74 | $2,041.74 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,089.30 / $2,238.72
| Professional | | $457.09 | $2,089.30 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,187.76 / $2,398.83
| Professional | | $1,995.26 | $2,187.76 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,677.35 / $10,471.29
| Facility | | $4,466.84 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $5,623.41
| Professional | | $3,162.28 | $3,162.28 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,230.27 / $3,467.37
| Professional | | $1,148.15 | $1,230.27 | $3,467.37 |