- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,570.88 / $11,220.18
| Facility | | $1,148.15 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $2,238.72
| Professional | | $912.01 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,782.79
| Facility | | $3,630.78 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,412.54 / $2,630.27
| Professional | | $891.25 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,691.53 / $7,413.10
| Facility | | $323.59 | $2,691.53 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $3,090.30
| Professional | | $977.24 | $1,584.89 | $3,090.30 |
- 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
- $891.25 / $1,288.25 / $2,344.23
| Professional | | $891.25 | $1,288.25 | $2,344.23 |