- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,570.88 / $11,481.54
| Facility | | $1,202.26 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,148.15 / $2,137.96
| Professional | | $954.99 | $1,148.15 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $16,982.44
| Facility | | $3,388.44 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $2,290.87
| Professional | | $912.01 | $1,202.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,819.70 / $7,244.36
| Facility | | $323.59 | $1,819.70 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,412.54 / $2,951.21
| Professional | | $891.25 | $1,412.54 | $2,951.21 |
- 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
- $870.96 / $1,202.26 / $2,187.76
| Professional | | $870.96 | $1,202.26 | $2,187.76 |