- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,342.03 / $5,829.12 / $11,658.20
| Facility | | $3,342.03 | $5,829.12 | $11,658.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,148.41 / $2,590.71 / $2,685.51
| Professional | | $2,148.41 | $2,590.71 | $2,685.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.60 / $9,478.26 / $17,152.49
| Facility | | $1,239.60 | $9,478.26 | $17,152.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.66 / $1,239.60 / $1,673.47
| Professional | | $1,053.66 | $1,239.60 | $1,673.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.42 / $4,107.25 / $5,055.07
| Facility | | $3,159.42 | $4,107.25 | $5,055.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,791.30 / $4,739.13
| Professional | | $3,159.42 | $3,791.30 | $4,739.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,053.62 / $5,971.04 / $12,321.69
| Facility | | $2,053.62 | $5,971.04 | $12,321.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.29 / $3,630.27 / $4,610.43
| Professional | | $1,636.29 | $3,630.27 | $4,610.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,472.20
| Professional | | $1,326.96 | $1,895.65 | $3,472.20 |