- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,890.45 / $7,762.47
| Facility | | $1,348.96 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,202.26 / $1,995.26
| Professional | | $977.24 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,309.57 / $10,471.29
| Facility | | $4,073.80 | $6,309.57 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $1,659.59
| Professional | | $1,071.52 | $1,412.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $7,244.36
| Facility | | $977.24 | $2,041.74 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $8,128.31
| Professional | | $954.99 | $1,258.93 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $1,621.81
| Professional | | $891.25 | $1,148.15 | $1,621.81 |