- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,311.31 / $5,754.40
| Professional | | $2,570.40 | $3,311.31 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $35,481.34 / $47,863.01
| Facility | | $29,512.09 | $35,481.34 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,801.89 / $4,466.84
| Professional | | $2,630.27 | $3,801.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,630.78 / $4,677.35
| Professional | | $2,089.30 | $3,630.78 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $5,248.07
| Facility | | $660.69 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $4,365.16
| Professional | | $1,995.26 | $2,884.03 | $4,365.16 |