- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,511.38 / $12,022.64
| Facility | | $4,365.16 | $8,511.38 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,479.11 / $3,019.95
| Professional | | $354.81 | $1,479.11 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,202.26 / $4,570.88
| Professional | | $380.19 | $1,202.26 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $2,691.53 / $3,311.31
| Professional | | $602.56 | $2,691.53 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $19,054.61 / $28,840.32
| Facility | | $11,481.54 | $19,054.61 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,778.28 / $4,073.80
| Professional | | $302.00 | $1,778.28 | $4,073.80 |
- 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
- $346.74 / $1,479.11 / $3,801.89
| Professional | | $346.74 | $1,479.11 | $3,801.89 |