- 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
- $2,238.72 / $2,884.03 / $5,888.44
| Professional | | $2,238.72 | $2,884.03 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,220.18 / $22,908.68
| Facility | | $3,715.35 | $11,220.18 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,548.13 / $6,606.93
| Professional | | $2,398.83 | $3,548.13 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $6,760.83 / $19,952.62
| Facility | | $630.96 | $6,760.83 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,890.45 / $8,511.38
| Professional | | $2,511.89 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $6,025.60
| Professional | | $2,187.76 | $3,162.28 | $6,025.60 |