- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $10,471.29
| Facility | | $1,862.09 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,122.02 / $2,818.38
| Professional | | $851.14 | $1,122.02 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $17,378.01 / $19,952.62
| Facility | | $8,709.64 | $17,378.01 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,905.46 / $2,398.83
| Professional | | $954.99 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,621.81 / $2,691.53
| Professional | | $1,096.48 | $1,621.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,905.46
| Professional | | $1,584.89 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,511.89
| Professional | | $933.25 | $1,318.26 | $2,511.89 |