- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $8,317.64 / $13,803.84
| Facility | | $1,023.29 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,570.40 / $5,623.41
| Professional | | $660.69 | $2,570.40 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $16,218.10 / $41,686.94
| Facility | | $9,120.11 | $16,218.10 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,630.78 / $5,248.07
| Professional | | $3,467.37 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,495.41 / $12,589.25
| Facility | | $2,187.76 | $5,495.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,981.07 / $6,456.54
| Professional | | $2,570.40 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,309.57 / $12,589.25
| Facility | | $2,951.21 | $6,309.57 | $12,589.25 |