- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,466.84 / $10,964.78
| Facility | | $1,230.27 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $2,570.40
| Professional | | $851.14 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,317.64 / $15,488.17
| Facility | | $3,019.95 | $8,317.64 | $15,488.17 |
- 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
- $1,584.89 / $2,754.23 / $7,943.28
| Facility | | $1,584.89 | $2,754.23 | $7,943.28 |
- 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
- $2,511.89 / $7,079.46 / $15,488.17
| Facility | | $2,511.89 | $7,079.46 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $2,137.96
| Professional | | $812.83 | $1,174.90 | $2,137.96 |