- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,466.84 / $10,964.78
| Facility | | $1,258.93 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,202.26 / $2,238.72
| Professional | | $977.24 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,912.51 / $16,982.44
| Facility | | $3,388.44 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $2,398.83
| Professional | | $933.25 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,905.46 / $7,585.78
| Facility | | $323.59 | $1,905.46 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $3,090.30
| Professional | | $912.01 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $2,290.87
| Professional | | $891.25 | $1,258.93 | $2,290.87 |