- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,011.87 / $11,481.54
| Facility | | $1,949.84 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,691.53 / $6,025.60
| Professional | | $2,290.87 | $2,691.53 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,772.37 / $17,782.79
| Facility | | $3,630.78 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,548.13 / $6,309.57
| Professional | | $2,344.23 | $3,548.13 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $6,606.93 / $18,620.87
| Facility | | $323.59 | $6,606.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,890.45 / $7,943.28
| Professional | | $2,511.89 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,244.36 / $16,595.87
| Facility | | $2,344.23 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $5,623.41
| Professional | | $2,137.96 | $3,162.28 | $5,623.41 |