- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,897.79 / $7,244.36
| Facility | | $2,344.23 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,495.41 / $8,317.64
| Professional | | $4,786.30 | $5,495.41 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $47,863.01 / $97,723.72
| Facility | | $22,908.68 | $47,863.01 | $97,723.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,754.40 / $8,912.51
| Professional | | $3,467.37 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,011.87 / $5,370.32
| Facility | | $4,466.84 | $5,011.87 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,943.28 / $18,620.87
| Professional | | $4,897.79 | $7,943.28 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,370.32 / $9,332.54
| Professional | | $3,890.45 | $5,370.32 | $9,332.54 |