- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,398.83
| Facility | | $1,258.93 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $7,079.46 / $9,120.11
| Professional | | $831.76 | $7,079.46 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $17,782.79 / $23,988.33
| Facility | | $15,135.61 | $17,782.79 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,122.02
| Professional | | $524.81 | $741.31 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $12,589.25
| Facility | | $2,511.89 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $1,445.44
| Professional | | $616.60 | $831.76 | $1,445.44 |