- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,786.30 / $11,481.54
| Facility | | $1,148.15 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $812.83 / $2,238.72
| Professional | | $645.65 | $812.83 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $16,218.10
| Facility | | $3,311.31 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $1,778.28
| Professional | | $645.65 | $954.99 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,238.72 / $6,165.95
| Facility | | $1,122.02 | $2,238.72 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $2,344.23
| Professional | | $676.08 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $870.96 / $1,621.81
| Professional | | $616.60 | $870.96 | $1,621.81 |