- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,440.91 / $7,539.10 / $14,263.20
| Facility | | $4,440.91 | $7,539.10 | $14,263.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,657.22 / $4,231.93 / $4,702.14
| Professional | | $3,657.22 | $4,231.93 | $4,702.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,068.02 / $7,667.10 / $20,375.93
| Facility | | $2,068.02 | $7,667.10 | $20,375.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,912.00 / $2,089.84 / $5,224.60
| Professional | | $1,912.00 | $2,089.84 | $5,224.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,022.55 / $8,104.06 / $16,247.86
| Facility | | $4,022.55 | $8,104.06 | $16,247.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,364.01 / $6,364.01 / $7,624.80
| Professional | | $6,364.01 | $6,364.01 | $7,624.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,702.14 / $4,963.37 / $6,269.52
| Facility | | $4,702.14 | $4,963.37 | $6,269.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $3,134.76 / $6,008.29
| Professional | | $2,194.33 | $3,134.76 | $6,008.29 |