- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,248.07 / $11,748.98
| Facility | | $1,949.84 | $5,248.07 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,890.45 / $7,762.47
| Professional | | $3,162.28 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,912.51 / $16,982.44
| Facility | | $3,388.44 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $8,912.51
| Professional | | $3,311.31 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $6,606.93 / $26,915.35
| Facility | | $398.11 | $6,606.93 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,370.32 / $11,481.54
| Professional | | $3,548.13 | $5,370.32 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,244.36 / $16,982.44
| Facility | | $1,995.26 | $7,244.36 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,365.16 / $8,128.31
| Professional | | $3,019.95 | $4,365.16 | $8,128.31 |