- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,168.69 / $11,748.98
| Facility | | $831.76 | $4,168.69 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,122.02 / $2,344.23
| Professional | | $389.05 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,888.44 / $13,803.84
| Facility | | $2,137.96 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,202.26 / $2,570.40
| Professional | | $407.38 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,548.13 / $12,302.69
| Facility | | $645.65 | $3,548.13 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,148.15 / $3,090.30
| Professional | | $416.87 | $1,148.15 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,122.02 / $2,454.71
| Professional | | $380.19 | $1,122.02 | $2,454.71 |