- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,943.28 / $16,595.87
| Facility | | $2,951.21 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,454.71 / $4,265.80
| Professional | | $2,137.96 | $2,454.71 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,137.96 / $2,754.23
| Professional | | $1,905.46 | $2,137.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,818.38 / $4,786.30
| Professional | | $1,659.59 | $2,818.38 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,754.23 / $5,011.87
| Facility | | $1,819.70 | $2,754.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $4,786.30
| Professional | | $1,778.28 | $2,511.89 | $4,786.30 |