- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,309.57 / $14,454.40
| Facility | | $1,949.84 | $6,309.57 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,025.60 / $12,589.25
| Professional | | $1,380.38 | $6,025.60 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $14,125.38 / $28,840.32
| Facility | | $5,623.41 | $14,125.38 | $28,840.32 |
- 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
- $5,011.87 / $10,964.78 / $19,498.45
| Facility | | $5,011.87 | $10,964.78 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,915.35
| Facility | | $3,630.78 | $11,220.18 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $29,512.09 / $61,659.50
| Professional | | $9,772.37 | $29,512.09 | $61,659.50 |