- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $11,481.54
| Facility | | $1,862.09 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,388.44 / $6,918.31
| Professional | | $2,754.23 | $3,388.44 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,488.17 / $30,199.52
| Facility | | $4,897.79 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,890.45 / $7,585.78
| Professional | | $2,570.40 | $3,890.45 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $8,317.64 / $22,908.68
| Facility | | $398.11 | $8,317.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,570.88 / $9,549.93
| Professional | | $2,818.38 | $4,570.88 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,918.31
| Professional | | $2,570.40 | $3,715.35 | $6,918.31 |