- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,128.61 / $10,715.19
| Facility | | $3,630.78 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,691.53 / $3,467.37
| Professional | | $1,949.84 | $2,691.53 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,623.41 / $9,772.37
| Facility | | $912.01 | $5,623.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $5,011.87
| Professional | | $794.33 | $1,258.93 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $20,892.96
| Facility | | $2,344.23 | $2,344.23 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,606.93 / $7,762.47
| Professional | | $4,897.79 | $6,606.93 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $6,309.57
| Professional | | $1,737.80 | $2,137.96 | $6,309.57 |