- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,248.07 / $12,022.64
| Facility | | $1,258.93 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $977.24 / $2,137.96
| Professional | | $831.76 | $977.24 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $11,220.18 / $24,547.09
| Facility | | $3,801.89 | $11,220.18 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,230.27 / $2,290.87
| Professional | | $831.76 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,818.38 / $10,964.78
| Facility | | $1,584.89 | $2,818.38 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,380.38 / $2,884.03
| Professional | | $912.01 | $1,380.38 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,481.54 / $26,915.35
| Facility | | $3,715.35 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $2,041.74
| Professional | | $776.25 | $1,096.48 | $2,041.74 |