- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,365.16 / $10,964.78
| Facility | | $1,148.15 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,949.84
| Professional | | $758.58 | $891.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $2,089.30
| Professional | | $707.95 | $1,096.48 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $6,309.57
| Facility | | $977.24 | $1,862.09 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $2,691.53
| Professional | | $831.76 | $1,258.93 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $977.24 / $1,819.70
| Professional | | $691.83 | $977.24 | $1,819.70 |