- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,011.87 / $11,748.98
| Facility | | $1,905.46 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,090.30 / $7,943.28
| Professional | | $2,454.71 | $3,090.30 | $7,943.28 |
- 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
- $2,454.71 / $3,630.78 / $6,918.31
| Professional | | $2,454.71 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $7,244.36 / $18,620.87
| Facility | | $398.11 | $7,244.36 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,073.80 / $8,709.64
| Professional | | $2,691.53 | $4,073.80 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $23,988.33
| Facility | | $3,630.78 | $10,232.93 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $6,025.60
| Professional | | $2,290.87 | $3,311.31 | $6,025.60 |