- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,370.32 / $12,302.69
| Facility | | $1,995.26 | $5,370.32 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $7,079.46
| Professional | | $2,511.89 | $2,884.03 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,511.38 / $16,595.87
| Facility | | $3,388.44 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,311.31 / $6,760.83
| Professional | | $2,187.76 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,248.07 / $19,498.45
| Facility | | $398.11 | $5,248.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,073.80 / $8,709.64
| Professional | | $2,630.27 | $4,073.80 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,235.94 / $6,025.60
| Professional | | $2,344.23 | $3,235.94 | $6,025.60 |