- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,943.28 / $16,595.87
| Facility | | $2,344.23 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $3,981.07
| Professional | | $1,737.80 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,754.23 / $4,466.84
| Professional | | $1,819.70 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $4,786.30
| Professional | | $2,137.96 | $2,818.38 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $5,011.87
| Facility | | $1,995.26 | $2,951.21 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $16,982.44 / $25,703.96
| Facility | | $2,884.03 | $16,982.44 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $4,466.84
| Professional | | $1,905.46 | $2,511.89 | $4,466.84 |