- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,495.41 / $13,489.63
| Facility | | $2,454.71 | $5,495.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,398.83 / $3,090.30
| Professional | | $1,905.46 | $2,398.83 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,623.41 / $16,218.10
| Facility | | $2,754.23 | $5,623.41 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,318.26 / $4,365.16
| Professional | | $1,174.90 | $1,318.26 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,309.57 / $15,488.17
| Facility | | $2,290.87 | $6,309.57 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,128.61 / $8,511.38
| Professional | | $4,073.80 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $4,168.69
| Facility | | $1,230.27 | $2,951.21 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $3,630.78
| Professional | | $1,230.27 | $1,737.80 | $3,630.78 |