- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $11,748.98
| Facility | | $1,862.09 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,466.84 / $8,317.64
| Professional | | $3,715.35 | $4,466.84 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $16,982.44
| Facility | | $3,548.13 | $9,332.54 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,466.84 / $8,709.64
| Professional | | $3,090.30 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $7,244.36 / $15,848.93
| Facility | | $398.11 | $7,244.36 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,370.32 / $11,481.54
| Professional | | $3,311.31 | $5,370.32 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,677.35 / $8,511.38
| Professional | | $3,311.31 | $4,677.35 | $8,511.38 |