- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,511.38 / $12,302.69
| Facility | | $4,466.84 | $8,511.38 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,230.27 / $4,073.80
| Professional | | $741.31 | $1,230.27 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,905.46 / $6,456.54
| Professional | | $1,096.48 | $1,905.46 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,089.30 / $2,951.21
| Professional | | $1,905.46 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $22,908.68 / $36,307.81
| Facility | | $14,454.40 | $22,908.68 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $4,786.30
| Professional | | $1,096.48 | $1,412.54 | $4,786.30 |
- 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
- $630.96 / $1,318.26 / $2,691.53
| Professional | | $630.96 | $1,318.26 | $2,691.53 |