- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,370.32 / $12,882.50
| Facility | | $1,258.93 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $3,235.94
| Professional | | $831.76 | $1,023.29 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,912.51 / $16,982.44
| Facility | | $3,311.31 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $2,238.72
| Professional | | $794.33 | $1,174.90 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,511.89 / $6,606.93
| Facility | | $323.59 | $2,511.89 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,348.96 / $2,884.03
| Professional | | $891.25 | $1,348.96 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,317.64 / $17,782.79
| Facility | | $2,951.21 | $8,317.64 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,995.26
| Professional | | $758.58 | $1,071.52 | $1,995.26 |