- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $11,748.98 / $30,902.95
| Facility | | $5,754.40 | $11,748.98 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $7,413.10
| Professional | | $4,073.80 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,471.29 / $32,359.37
| Facility | | $4,897.79 | $10,471.29 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $478.63 / $8,317.64
| Professional | | $426.58 | $478.63 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $10,964.78 / $29,512.09
| Facility | | $4,365.16 | $10,964.78 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $9,772.37 / $18,620.87
| Professional | | $7,762.47 | $9,772.37 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,760.83 / $8,128.31
| Facility | | $4,073.80 | $6,760.83 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $8,128.31
| Professional | | $2,818.38 | $4,073.80 | $8,128.31 |