- 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
- $1,905.46 / $2,290.87 / $5,128.61
| Professional | | $1,905.46 | $2,290.87 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $28,183.83
| Facility | | $4,677.35 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,951.21 / $5,623.41
| Professional | | $1,949.84 | $2,951.21 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,128.61 / $14,454.40
| Facility | | $398.11 | $5,128.61 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,388.44 / $7,244.36
| Professional | | $2,089.30 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,754.23 / $5,128.61
| Professional | | $1,949.84 | $2,754.23 | $5,128.61 |