- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,495.41 / $7,762.47
| Facility | | $1,148.15 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,122.02 / $1,380.38
| Professional | | $660.69 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,803.84 / $17,378.01 / $35,481.34
| Professional | | $13,803.84 | $17,378.01 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,023.29 / $2,511.89
| Professional | | $977.24 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,489.63 / $63,095.73
| Facility | | $4,897.79 | $13,489.63 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,862.09 / $3,388.44
| Professional | | $1,288.25 | $1,862.09 | $3,388.44 |