- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $11,481.54
| Facility | | $1,862.09 | $5,370.32 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,073.80 / $7,943.28
| Professional | | $3,548.13 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $26,915.35
| Facility | | $4,677.35 | $13,489.63 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,370.32 / $9,549.93
| Professional | | $3,548.13 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $8,128.31 / $27,542.29
| Facility | | $398.11 | $8,128.31 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,888.44 / $12,022.64
| Professional | | $3,801.89 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $28,840.32
| Facility | | $3,548.13 | $11,481.54 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $8,709.64
| Professional | | $3,311.31 | $4,786.30 | $8,709.64 |