- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $13,489.63 / $20,417.38
| Facility | | $1,905.46 | $13,489.63 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $2,238.72
| Professional | | $1,348.96 | $1,905.46 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $30,902.95 / $61,659.50
| Facility | | $16,982.44 | $30,902.95 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,290.87 / $4,073.80
| Facility | | $1,862.09 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $54.95
| Professional | | $30.20 | $30.20 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,754.23 / $5,011.87
| Professional | | $1,778.28 | $2,754.23 | $5,011.87 |