- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,168.69 / $4,897.79
| Facility | | $2,344.23 | $4,168.69 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,235.94 / $6,918.31
| Professional | | $2,818.38 | $3,235.94 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $40,738.03 / $57,543.99
| Facility | | $16,982.44 | $40,738.03 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $5,011.87
| Professional | | $2,398.83 | $3,162.28 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,884.03 / $3,090.30
| Facility | | $2,630.27 | $2,884.03 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $6,309.57
| Professional | | $2,691.53 | $3,801.89 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,467.37 / $5,754.40
| Professional | | $2,511.89 | $3,467.37 | $5,754.40 |