- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $11,481.54
| Facility | | $1,862.09 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,454.71 / $5,370.32
| Professional | | $2,041.74 | $2,454.71 | $5,370.32 |
- 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
- $1,995.26 / $2,951.21 / $5,888.44
| Professional | | $1,995.26 | $2,951.21 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,073.80 / $15,488.17
| Facility | | $398.11 | $4,073.80 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $7,244.36
| Professional | | $2,238.72 | $3,388.44 | $7,244.36 |
- 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
- $1,905.46 / $2,754.23 / $5,128.61
| Professional | | $1,905.46 | $2,754.23 | $5,128.61 |