- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,128.61 / $11,481.54
| Facility | | $1,949.84 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,630.27 / $6,760.83
| Professional | | $2,187.76 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,762.47 / $14,791.08
| Facility | | $2,754.23 | $7,762.47 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,090.30 / $5,754.40
| Professional | | $2,238.72 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $7,762.47 / $22,908.68
| Facility | | $616.60 | $7,762.47 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,630.78 / $7,762.47
| Professional | | $2,344.23 | $3,630.78 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $5,623.41
| Professional | | $2,137.96 | $2,951.21 | $5,623.41 |