- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,495.41 / $11,748.98
| Facility | | $1,905.46 | $5,495.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,309.57 / $11,481.54
| Professional | | $4,365.16 | $6,309.57 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $12,302.69 / $26,915.35
| Facility | | $5,248.07 | $12,302.69 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $13,182.57 / $21,379.62
| Professional | | $776.25 | $13,182.57 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $33,884.42 / $81,283.05
| Facility | | $7,762.47 | $33,884.42 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $12,302.69 / $15,488.17
| Professional | | $724.44 | $12,302.69 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,915.35
| Facility | | $3,630.78 | $11,220.18 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,489.63 / $24,547.09
| Professional | | $8,912.51 | $13,489.63 | $24,547.09 |