- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,413.10 / $11,748.98
| Facility | | $4,466.84 | $7,413.10 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $8,912.51
| Professional | | $2,754.23 | $3,311.31 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $10,232.93
| Professional | | $2,951.21 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,890.45 / $5,128.61
| Professional | | $3,548.13 | $3,890.45 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $19,952.62 / $38,018.94
| Facility | | $14,454.40 | $19,952.62 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,073.80 / $13,182.57
| Professional | | $2,951.21 | $4,073.80 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,120.11 / $21,379.62
| Facility | | $4,570.88 | $9,120.11 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,388.44 / $7,762.47
| Professional | | $2,511.89 | $3,388.44 | $7,762.47 |