- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,570.88 / $11,481.54
| Facility | | $1,122.02 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $2,238.72
| Professional | | $851.14 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $12,022.64 / $22,908.68
| Facility | | $4,168.69 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $2,344.23
| Professional | | $851.14 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,290.87 / $6,309.57
| Facility | | $398.11 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,445.44 / $3,019.95
| Professional | | $933.25 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $2,187.76
| Professional | | $812.83 | $1,174.90 | $2,187.76 |