- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,235.94 / $5,011.87
| Facility | | $1,096.48 | $3,235.94 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $3,019.95 / $4,365.16
| Professional | | $954.99 | $3,019.95 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,754.40 / $12,589.25
| Facility | | $2,511.89 | $5,754.40 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,513.56 / $5,011.87
| Professional | | $537.03 | $1,513.56 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,623.41 / $11,748.98
| Facility | | $398.11 | $5,623.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,677.35 / $8,912.51
| Professional | | $2,884.03 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $15,488.17
| Facility | | $2,398.83 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,090.30 / $7,244.36
| Professional | | $1,659.59 | $3,090.30 | $7,244.36 |