- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,128.61 / $11,481.54
| Facility | | $1,862.09 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,235.94 / $7,079.46
| Professional | | $2,570.40 | $3,235.94 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $26,915.35
| Facility | | $4,677.35 | $12,302.69 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,801.89 / $7,413.10
| Professional | | $2,570.40 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $6,025.60 / $19,498.45
| Facility | | $630.96 | $6,025.60 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,265.80 / $9,120.11
| Professional | | $2,818.38 | $4,265.80 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $6,456.54
| Professional | | $2,454.71 | $3,467.37 | $6,456.54 |