- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,715.35 / $9,772.37
| Facility | | $1,174.90 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,148.15 / $2,511.89
| Professional | | $954.99 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $12,022.64
| Facility | | $2,290.87 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,288.25 / $2,511.89
| Professional | | $870.96 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,019.95 / $8,709.64
| Facility | | $323.59 | $3,019.95 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,548.82 / $3,311.31
| Professional | | $977.24 | $1,548.82 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $2,344.23
| Professional | | $891.25 | $1,258.93 | $2,344.23 |