- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,760.83 / $17,782.79
| Facility | | $3,311.31 | $6,760.83 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $4,466.84
| Professional | | $2,570.40 | $3,162.28 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,011.87 / $17,782.79
| Facility | | $3,548.13 | $5,011.87 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $5,754.40
| Professional | | $851.14 | $1,258.93 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,413.10 / $16,595.87
| Facility | | $2,511.89 | $7,413.10 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,623.41 / $10,715.19
| Professional | | $4,466.84 | $5,623.41 | $10,715.19 |
- 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 |