- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,128.61 / $9,772.37
| Facility | | $1,445.44 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $8,128.31 / $11,748.98
| Professional | | $2,238.72 | $8,128.31 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $19,498.45 / $32,359.37
| Facility | | $12,589.25 | $19,498.45 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,709.64 / $35,481.34
| Facility | | $3,235.94 | $8,709.64 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $912.01 / $72,443.60
| Professional | | $645.65 | $912.01 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $12,302.69 / $21,379.62
| Facility | | $3,467.37 | $12,302.69 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,479.11
| Professional | | $602.56 | $812.83 | $1,479.11 |