- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $19,498.45 / $29,512.09
| Facility | | $2,398.83 | $19,498.45 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,584.89 / $12,302.69
| Professional | | $630.96 | $1,584.89 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,122.02 / $10,964.78
| Professional | | $512.86 | $1,122.02 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,288.25 / $20,417.38
| Professional | | $501.19 | $1,288.25 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $15,135.61 / $26,302.68
| Facility | | $4,466.84 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $7,079.46 / $16,218.10
| Professional | | $741.31 | $7,079.46 | $16,218.10 |