- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,248.07 / $12,022.64
| Facility | | $1,288.25 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $2,344.23
| Professional | | $891.25 | $1,071.52 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,709.64 / $16,595.87
| Facility | | $3,548.13 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $2,344.23
| Professional | | $851.14 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,398.83 / $6,760.83
| Facility | | $398.11 | $2,398.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $3,162.28
| Professional | | $912.01 | $1,445.44 | $3,162.28 |
- 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
- $831.76 / $1,202.26 / $2,187.76
| Professional | | $831.76 | $1,202.26 | $2,187.76 |