- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $11,481.54
| Facility | | $1,862.09 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,235.94 / $6,918.31
| Professional | | $2,570.40 | $3,235.94 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,481.54 / $22,387.21
| Facility | | $4,073.80 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,467.37 / $6,760.83
| Professional | | $2,290.87 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $8,511.38 / $23,988.33
| Facility | | $323.59 | $8,511.38 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,168.69 / $9,120.11
| Professional | | $2,454.71 | $4,168.69 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $6,309.57
| Professional | | $2,344.23 | $3,388.44 | $6,309.57 |