- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,918.31 / $11,748.98
| Facility | | $4,365.16 | $6,918.31 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $3,467.37
| Professional | | $1,230.27 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,862.09 / $4,365.16
| Professional | | $1,288.25 | $1,862.09 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $2,187.76
| Professional | | $1,288.25 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $35,481.34 / $67,608.30
| Facility | | $25,118.86 | $35,481.34 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $5,495.41
| Professional | | $1,258.93 | $1,819.70 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,772.37 / $25,118.86
| Facility | | $4,570.88 | $9,772.37 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $3,467.37
| Professional | | $1,047.13 | $1,412.54 | $3,467.37 |