- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,248.07 / $10,471.29
| Facility | | $4,570.88 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,737.80 / $2,398.83
| Professional | | $660.69 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $26,915.35
| Facility | | $8,912.51 | $17,378.01 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $2,511.89
| Professional | | $851.14 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $1,659.59
| Facility | | $851.14 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,290.87 / $3,981.07
| Professional | | $1,995.26 | $2,290.87 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,511.38 / $11,748.98
| Facility | | $5,370.32 | $8,511.38 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,630.27 / $5,128.61
| Professional | | $741.31 | $2,630.27 | $5,128.61 |