- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,754.40 / $12,589.25
| Facility | | $1,862.09 | $5,754.40 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $11,220.18
| Professional | | $3,630.78 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $10,471.29 / $18,197.01
| Facility | | $4,365.16 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $316.23 / $331.13
| Professional | | $295.12 | $316.23 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $2,951.21 / $7,762.47
| Facility | | $64.57 | $2,951.21 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,715.19
| Facility | | $1,584.89 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,022.64 / $20,892.96
| Professional | | $4,466.84 | $12,022.64 | $20,892.96 |