- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,370.32 / $12,022.64
| Facility | | $1,819.70 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,677.35 / $9,772.37
| Professional | | $3,548.13 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,511.38 / $16,982.44
| Facility | | $2,951.21 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,311.31 / $7,079.46
| Professional | | $2,238.72 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $8,709.64 / $24,547.09
| Facility | | $323.59 | $8,709.64 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $11,748.98
| Professional | | $3,467.37 | $6,165.95 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,715.35 / $11,220.18
| Facility | | $912.01 | $3,715.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $8,709.64
| Professional | | $3,311.31 | $4,786.30 | $8,709.64 |