- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $13,489.63 / $20,417.38
| Facility | | $1,445.44 | $13,489.63 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $2,089.30
| Professional | | $1,288.25 | $1,659.59 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,174.90 / $1,412.54
| Professional | | $1,096.48 | $1,174.90 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,595.87 / $19,054.61
| Facility | | $11,748.98 | $16,595.87 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $3,090.30
| Facility | | $1,230.27 | $1,862.09 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- 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
- $1,819.70 / $2,454.71 / $4,466.84
| Professional | | $1,819.70 | $2,454.71 | $4,466.84 |