- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $8,511.38 / $18,197.01
| Facility | | $2,454.71 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,162.28 / $3,801.89
| Professional | | $2,344.23 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,220.18 / $18,620.87
| Facility | | $4,786.30 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $3,890.45
| Professional | | $1,621.81 | $1,621.81 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,511.89 / $10,232.93
| Facility | | $2,041.74 | $2,511.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,818.38 / $5,623.41
| Professional | | $1,819.70 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,495.41 / $6,165.95
| Professional | | $5,370.32 | $5,495.41 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,890.45 / $3,890.45
| Professional | | $2,691.53 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $2,344.23
| Professional | | $1,621.81 | $1,621.81 | $2,344.23 |