- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,897.79 / $7,079.46
| Facility | | $2,344.23 | $4,897.79 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,248.07 / $8,709.64
| Professional | | $4,466.84 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $19,952.62 / $27,542.29
| Facility | | $9,120.11 | $19,952.62 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,467.37 / $5,128.61
| Professional | | $2,290.87 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,677.35 / $5,370.32
| Facility | | $4,570.88 | $4,677.35 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $8,317.64 / $8,317.64
| Facility | | $758.58 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,495.41 / $9,772.37
| Professional | | $2,238.72 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,623.41 / $12,022.64
| Facility | | $1,023.29 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,248.07 / $8,128.31
| Professional | | $3,801.89 | $5,248.07 | $8,128.31 |