- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $10,471.29 / $15,135.61
| Facility | | $4,570.88 | $10,471.29 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $2,290.87
| Professional | | $1,096.48 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $22,908.68 / $31,622.78
| Facility | | $8,912.51 | $22,908.68 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,715.35 / $4,365.16
| Professional | | $1,479.11 | $3,715.35 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $31,622.78 / $47,863.01
| Facility | | $13,803.84 | $31,622.78 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,570.40 / $5,370.32
| Professional | | $1,445.44 | $2,570.40 | $5,370.32 |