- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,888.44 / $12,022.64
| Facility | | $1,819.70 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,888.44 / $13,803.84
| Professional | | $5,248.07 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $12,302.69 / $23,988.33
| Facility | | $4,570.88 | $12,302.69 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,079.46 / $14,125.38
| Professional | | $4,265.80 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $12,882.50 / $38,018.94
| Facility | | $549.54 | $12,882.50 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,912.51 / $18,620.87
| Professional | | $5,370.32 | $8,912.51 | $18,620.87 |
- 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
- $5,128.61 / $7,244.36 / $13,182.57
| Professional | | $5,128.61 | $7,244.36 | $13,182.57 |