- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,120.11 / $16,595.87
| Facility | | $5,370.32 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,786.30 / $8,317.64
| Professional | | $3,981.07 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $6,025.60
| Professional | | $3,388.44 | $4,365.16 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,025.60 / $9,772.37
| Professional | | $3,630.78 | $6,025.60 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,888.44 / $10,715.19
| Facility | | $4,073.80 | $5,888.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,128.61 / $9,332.54
| Professional | | $3,801.89 | $5,128.61 | $9,332.54 |