- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $10,232.93 / $13,803.84
| Facility | | $4,570.88 | $10,232.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $602.56 / $1,621.81
| Professional | | $537.03 | $602.56 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $912.01 / $2,089.30
| Professional | | $457.09 | $912.01 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,047.13
| Professional | | $588.84 | $812.83 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $41,686.94 / $66,069.34
| Facility | | $26,302.68 | $41,686.94 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,513.56
| Professional | | $512.86 | $741.31 | $1,513.56 |
- 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
- $316.23 / $588.84 / $1,230.27
| Professional | | $316.23 | $588.84 | $1,230.27 |