- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,715.35 / $9,772.37
| Facility | | $1,096.48 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $2,041.74
| Professional | | $758.58 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,481.54 / $22,908.68
| Facility | | $4,073.80 | $11,481.54 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $2,187.76
| Professional | | $794.33 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,041.74 / $5,754.40
| Facility | | $398.11 | $2,041.74 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,318.26 / $2,754.23
| Professional | | $851.14 | $1,318.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,248.07 / $12,022.64
| Facility | | $1,905.46 | $5,248.07 | $12,022.64 |
- 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 |