- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,760.83 / $17,782.79
| Facility | | $3,235.94 | $6,760.83 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,311.31 / $4,897.79
| Professional | | $2,570.40 | $3,311.31 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $18,620.87
| Facility | | $1,995.26 | $5,754.40 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $5,248.07
| Professional | | $575.44 | $831.76 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,413.10 / $16,982.44
| Facility | | $2,511.89 | $7,413.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,370.32 / $9,772.37
| Professional | | $2,137.96 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $4,677.35
| Facility | | $2,344.23 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $4,677.35
| Professional | | $1,621.81 | $2,344.23 | $4,677.35 |