- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,244.36 / $19,498.45
| Facility | | $3,467.37 | $7,244.36 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,388.44 / $4,786.30
| Professional | | $2,754.23 | $3,388.44 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,079.46 / $20,417.38
| Facility | | $3,019.95 | $7,079.46 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $229.09 / $5,248.07
| Professional | | $208.93 | $229.09 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,760.83 / $16,982.44
| Facility | | $2,691.53 | $6,760.83 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,165.95 / $11,481.54
| Professional | | $4,897.79 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,168.69 / $5,011.87
| Facility | | $2,511.89 | $4,168.69 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,511.89 / $5,011.87
| Professional | | $1,737.80 | $2,511.89 | $5,011.87 |