- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,897.79 / $10,471.29
| Facility | | $2,818.38 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,905.46 / $4,466.84
| Professional | | $1,479.11 | $1,905.46 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $31,622.78
| Facility | | $8,912.51 | $17,378.01 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,388.44 / $3,890.45
| Professional | | $1,479.11 | $3,388.44 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,570.40 / $4,168.69
| Professional | | $1,698.24 | $2,570.40 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,884.03
| Professional | | $2,511.89 | $2,511.89 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,454.71 / $4,786.30
| Professional | | $1,584.89 | $2,454.71 | $4,786.30 |