- 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
- $2,238.72 / $2,691.53 / $5,011.87
| Professional | | $2,238.72 | $2,691.53 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $9,332.54 / $16,982.44
| Facility | | $3,467.37 | $9,332.54 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,691.53 / $5,248.07
| Professional | | $2,041.74 | $2,691.53 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $4,265.80 / $12,022.64
| Facility | | $371.54 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,235.94 / $6,918.31
| Professional | | $2,041.74 | $3,235.94 | $6,918.31 |
- 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
- $2,041.74 / $2,818.38 / $5,128.61
| Professional | | $2,041.74 | $2,818.38 | $5,128.61 |