- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,897.79 / $10,471.29
| Facility | | $4,466.84 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,951.21 / $7,413.10
| Professional | | $2,344.23 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $14,125.38 / $16,595.87
| Facility | | $8,317.64 | $14,125.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,495.41 / $6,309.57
| Professional | | $2,344.23 | $5,495.41 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,981.07 / $6,606.93
| Professional | | $2,754.23 | $3,981.07 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,466.84
| Professional | | $4,265.80 | $4,265.80 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,801.89 / $7,762.47
| Professional | | $2,570.40 | $3,801.89 | $7,762.47 |