- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,897.79 / $11,481.54
| Facility | | $1,445.44 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $4,365.16 / $7,244.36
| Professional | | $616.60 | $4,365.16 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,481.54 / $26,915.35
| Facility | | $5,370.32 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $870.96 / $3,162.28
| Professional | | $478.63 | $870.96 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $36,307.81 / $89,125.09
| Facility | | $15,135.61 | $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
- $436.52 / $891.25 / $10,471.29
| Professional | | $436.52 | $891.25 | $10,471.29 |