- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,585.78 / $11,748.98
| Facility | | $4,466.84 | $7,585.78 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,949.84
| Professional | | $660.69 | $812.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,023.29 / $3,235.94
| Professional | | $316.23 | $1,023.29 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $1,445.44
| Professional | | $794.33 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $41,686.94 / $66,069.34
| Facility | | $26,915.35 | $41,686.94 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,819.70
| Professional | | $616.60 | $891.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,715.19 / $29,512.09
| Facility | | $5,128.61 | $10,715.19 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,698.24
| Professional | | $501.19 | $776.25 | $1,698.24 |