- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $12,022.64
| Facility | | $1,862.09 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $9,120.11 / $10,964.78
| Professional | | $2,511.89 | $9,120.11 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $11,748.98 / $28,840.32
| Facility | | $5,754.40 | $11,748.98 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $8,317.64 / $17,782.79
| Professional | | $741.31 | $8,317.64 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $47,863.01
| Facility | | $2,137.96 | $2,137.96 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,456.54 / $12,882.50
| Professional | | $5,623.41 | $6,456.54 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $33,884.42
| Facility | | $3,630.78 | $12,022.64 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,589.25 / $21,877.62
| Professional | | $4,466.84 | $12,589.25 | $21,877.62 |