- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,022.64
| Facility | | $1,995.26 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,981.07 / $7,585.78
| Professional | | $3,388.44 | $3,981.07 | $7,585.78 |
- 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
- $3,235.94 / $4,365.16 / $8,317.64
| Professional | | $3,235.94 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $6,309.57 / $22,387.21
| Facility | | $398.11 | $6,309.57 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,248.07 / $10,232.93
| Professional | | $3,090.30 | $5,248.07 | $10,232.93 |
- 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
- $3,162.28 / $4,466.84 / $7,943.28
| Professional | | $3,162.28 | $4,466.84 | $7,943.28 |