- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,244.36 / $25,703.96
| Facility | | $5,248.07 | $7,244.36 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,365.16 / $6,309.57
| Professional | | $3,019.95 | $4,365.16 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,772.37 / $15,488.17
| Facility | | $5,370.32 | $9,772.37 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $741.31
| Professional | | $562.34 | $660.69 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $38,018.94
| Facility | | $3,235.94 | $5,248.07 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,011.87 / $5,011.87
| Facility | | $2,089.30 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,511.89 / $7,079.46
| Professional | | $2,089.30 | $2,511.89 | $7,079.46 |