- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,786.30 / $8,511.38
| Facility | | $1,288.25 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,905.46 / $6,165.95
| Professional | | $1,096.48 | $1,905.46 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $64,565.42 / $64,565.42
| Professional | | $54,954.09 | $64,565.42 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $14,125.38 / $20,417.38
| Facility | | $3,890.45 | $14,125.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,981.07 / $8,317.64
| Facility | | $1,023.29 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,659.59 / $7,244.36
| Professional | | $707.95 | $1,659.59 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,466.84 / $18,620.87
| Facility | | $2,344.23 | $4,466.84 | $18,620.87 |