- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,754.23 / $8,912.51
| Facility | | $1,202.26 | $2,754.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $5,248.07 / $7,943.28
| Professional | | $776.25 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,715.19 / $17,782.79
| Facility | | $6,918.31 | $10,715.19 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,819.70 / $7,943.28
| Professional | | $870.96 | $1,819.70 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $6,918.31 / $20,417.38
| Facility | | $933.25 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,918.31 / $41,686.94
| Professional | | $1,479.11 | $6,918.31 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $12,302.69 / $20,892.96
| Facility | | $3,467.37 | $12,302.69 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,412.54 / $7,585.78
| Professional | | $724.44 | $1,412.54 | $7,585.78 |