- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,786.30 / $11,481.54
| Facility | | $1,862.09 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,691.53 / $5,370.32
| Professional | | $2,187.76 | $2,691.53 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $17,378.01
| Facility | | $3,548.13 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $5,248.07
| Professional | | $2,089.30 | $2,754.23 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $4,168.69 / $11,748.98
| Facility | | $371.54 | $4,168.69 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,235.94 / $6,760.83
| Professional | | $1,995.26 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,818.38 / $5,128.61
| Professional | | $1,995.26 | $2,818.38 | $5,128.61 |