- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,495.41 / $10,471.29
| Facility | | $2,398.83 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $4,466.84 / $6,606.93
| Professional | | $630.96 | $4,466.84 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,760.83 / $17,378.01
| Facility | | $1,905.46 | $6,760.83 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $891.25 / $52,480.75
| Professional | | $457.09 | $891.25 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $8,912.51 / $15,848.93
| Facility | | $2,570.40 | $8,912.51 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $2,344.23
| Professional | | $436.52 | $891.25 | $2,344.23 |