- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,248.07 / $34,673.69
| Facility | | $3,019.95 | $5,248.07 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,995.26 / $4,677.35
| Professional | | $1,548.82 | $1,995.26 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $17,378.01 / $28,840.32
| Facility | | $8,709.64 | $17,378.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,548.13 / $3,981.07
| Professional | | $1,548.82 | $3,548.13 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $63,095.73 / $79,432.82
| Facility | | $46,773.51 | $63,095.73 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,454.71 / $4,365.16
| Professional | | $1,778.28 | $2,454.71 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $3,090.30
| Professional | | $2,691.53 | $2,691.53 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $5,128.61
| Professional | | $1,698.24 | $2,398.83 | $5,128.61 |