- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $10,471.29
| Facility | | $1,949.84 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,698.24
| Professional | | $398.11 | $602.56 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $380.19 / $562.34
| Professional | | $177.83 | $380.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $7,413.10
| Facility | | $575.44 | $1,445.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,202.26 / $8,912.51
| Professional | | $489.78 | $1,202.26 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,122.02 / $5,128.61
| Facility | | $338.84 | $1,122.02 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,202.26 / $8,912.51
| Professional | | $478.63 | $1,202.26 | $8,912.51 |