- 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
- $2,570.40 / $2,951.21 / $6,165.95
| Professional | | $2,570.40 | $2,951.21 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,964.78 / $22,908.68
| Facility | | $3,801.89 | $10,964.78 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,918.31
| Professional | | $2,454.71 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,754.40 / $19,952.62
| Facility | | $398.11 | $5,754.40 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,168.69 / $8,709.64
| Professional | | $2,754.23 | $4,168.69 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,982.44
| Facility | | $2,041.74 | $7,244.36 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $6,165.95
| Professional | | $2,398.83 | $3,388.44 | $6,165.95 |