- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,128.61 / $11,748.98
| Facility | | $1,949.84 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $6,165.95
| Professional | | $2,398.83 | $2,884.03 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,772.37 / $17,782.79
| Facility | | $3,715.35 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,715.35 / $6,918.31
| Professional | | $2,511.89 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,623.41 / $19,952.62
| Facility | | $398.11 | $5,623.41 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,168.69 / $8,709.64
| Professional | | $2,691.53 | $4,168.69 | $8,709.64 |
- 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
- $2,344.23 / $3,311.31 / $6,165.95
| Professional | | $2,344.23 | $3,311.31 | $6,165.95 |