- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,772.37 / $14,125.38
| Facility | | $4,466.84 | $9,772.37 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $2,398.83 / $4,365.16
| Professional | | $645.65 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,570.40 / $7,413.10
| Professional | | $691.83 | $2,570.40 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $4,466.84
| Professional | | $2,454.71 | $3,235.94 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $19,054.61 / $30,199.52
| Facility | | $12,022.64 | $19,054.61 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $2,884.03 / $7,413.10
| Professional | | $562.34 | $2,884.03 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $11,220.18
| Facility | | $2,951.21 | $6,606.93 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $5,623.41
| Professional | | $575.44 | $1,995.26 | $5,623.41 |