- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,248.07 / $11,748.98
| Facility | | $1,862.09 | $5,248.07 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $8,511.38
| Professional | | $3,162.28 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,803.84 / $28,183.83
| Facility | | $4,897.79 | $13,803.84 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $9,332.54
| Professional | | $3,311.31 | $4,897.79 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $10,000.00 / $28,840.32
| Facility | | $323.59 | $10,000.00 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,623.41 / $12,022.64
| Professional | | $3,467.37 | $5,623.41 | $12,022.64 |
- 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
- $3,235.94 / $4,677.35 / $8,709.64
| Professional | | $3,235.94 | $4,677.35 | $8,709.64 |