- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,365.16 / $10,964.78
| Facility | | $1,096.48 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $812.83 / $1,778.28
| Professional | | $707.95 | $812.83 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,417.38
| Facility | | $3,162.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $1,905.46
| Professional | | $691.83 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,995.26 / $5,623.41
| Facility | | $954.99 | $1,995.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,174.90 / $2,454.71
| Professional | | $758.58 | $1,174.90 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $1,737.80
| Professional | | $660.69 | $933.25 | $1,737.80 |