- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,549.93 / $19,498.45
| Facility | | $3,630.78 | $9,549.93 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,128.31 / $12,022.64
| Professional | | $3,235.94 | $8,128.31 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $18,620.87 / $25,703.96
| Facility | | $11,748.98 | $18,620.87 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $1,698.24
| Professional | | $933.25 | $1,174.90 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $10,471.29
| Facility | | $8,128.31 | $8,128.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Facility | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Professional | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |