- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $16,595.87
| Facility | | $9,772.37 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $2,691.53
| Professional | | $1,348.96 | $1,905.46 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,691.53 / $10,232.93
| Facility | | $977.24 | $2,691.53 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,398.83 / $6,025.60
| Professional | | $1,230.27 | $2,398.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,128.31 / $35,481.34
| Professional | | $7,585.78 | $8,128.31 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,691.53 / $3,801.89
| Facility | | $977.24 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,548.13 / $7,943.28
| Professional | | $1,288.25 | $3,548.13 | $7,943.28 |