- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,897.79 / $11,481.54
| Facility | | $1,584.89 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,466.84 / $5,623.41
| Professional | | $1,258.93 | $4,466.84 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $11,481.54 / $26,915.35
| Facility | | $5,248.07 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,071.52 / $3,981.07
| Professional | | $407.38 | $1,071.52 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $36,307.81 / $89,125.09
| Facility | | $8,317.64 | $36,307.81 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $14,454.40 / $16,982.44
| Professional | | $13,489.63 | $14,454.40 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,302.68
| Facility | | $3,630.78 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,412.54 / $4,570.88
| Professional | | $870.96 | $1,412.54 | $4,570.88 |