- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,754.40 / $13,182.57
| Facility | | $2,089.30 | $5,754.40 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $6,165.95
| Professional | | $2,884.03 | $3,388.44 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,481.54 / $22,387.21
| Facility | | $4,168.69 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,715.35 / $7,079.46
| Professional | | $2,691.53 | $3,715.35 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,370.32 / $21,379.62
| Facility | | $398.11 | $5,370.32 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,365.16 / $8,709.64
| Professional | | $2,691.53 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,884.03 / $9,772.37
| Facility | | $537.03 | $2,884.03 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $6,606.93
| Professional | | $2,691.53 | $3,801.89 | $6,606.93 |