- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,248.07 / $12,589.25
| Facility | | $1,318.26 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $977.24 / $2,398.83
| Professional | | $831.76 | $977.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,128.31 / $15,135.61
| Facility | | $2,818.38 | $8,128.31 | $15,135.61 |
- 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
- $1,071.52 / $2,511.89 / $10,232.93
| Facility | | $1,071.52 | $2,511.89 | $10,232.93 |
- 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
- $1,949.84 / $6,606.93 / $15,135.61
| Facility | | $1,949.84 | $6,606.93 | $15,135.61 |
- 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 |