- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,897.79 / $11,748.98
| Facility | | $1,288.25 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $954.99 / $2,187.76
| Professional | | $812.83 | $954.99 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,232.93 / $22,387.21
| Facility | | $3,548.13 | $10,232.93 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,148.15 / $2,187.76
| Professional | | $758.58 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,818.38 / $8,128.31
| Facility | | $1,513.56 | $2,818.38 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,348.96 / $2,884.03
| Professional | | $891.25 | $1,348.96 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $1,949.84
| Professional | | $741.31 | $1,071.52 | $1,949.84 |