- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,248.07 / $11,748.98
| Facility | | $1,819.70 | $5,248.07 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,168.69 / $8,317.64
| Professional | | $3,311.31 | $4,168.69 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $14,454.40 / $28,840.32
| Facility | | $4,466.84 | $14,454.40 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,897.79 / $9,549.93
| Professional | | $3,235.94 | $4,897.79 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $8,912.51 / $22,908.68
| Facility | | $398.11 | $8,912.51 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,754.40 / $11,481.54
| Professional | | $3,548.13 | $5,754.40 | $11,481.54 |
- 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
- $3,235.94 / $4,786.30 / $8,511.38
| Professional | | $3,235.94 | $4,786.30 | $8,511.38 |