- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $9,332.54 / $20,417.38
| Facility | | $4,168.69 | $9,332.54 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $3,019.95
| Professional | | $1,412.54 | $1,905.46 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $223.87 / $4,677.35
| Professional | | $204.17 | $223.87 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,309.57 / $45,708.82
| Facility | | $3,981.07 | $6,309.57 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $12,022.64
| Professional | | $2,884.03 | $3,630.78 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $2,511.89
| Facility | | $1,047.13 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $3,467.37
| Professional | | $1,047.13 | $1,513.56 | $3,467.37 |