- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,011.87 / $11,481.54
| Facility | | $1,862.09 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,388.44 / $6,606.93
| Professional | | $2,818.38 | $3,388.44 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $13,489.63 / $26,915.35
| Facility | | $4,466.84 | $13,489.63 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,365.16 / $7,943.28
| Professional | | $2,884.03 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $6,760.83 / $22,908.68
| Facility | | $398.11 | $6,760.83 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,786.30 / $9,772.37
| Professional | | $3,090.30 | $4,786.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $28,840.32
| Facility | | $3,548.13 | $11,481.54 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $7,079.46
| Professional | | $2,691.53 | $3,801.89 | $7,079.46 |