- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,786.30 / $11,481.54
| Facility | | $1,096.48 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,778.28
| Professional | | $602.56 | $741.31 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $10,471.29
| Facility | | $954.99 | $2,884.03 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,737.80
| Professional | | $616.60 | $912.01 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,187.76 / $5,011.87
| Facility | | $1,202.26 | $2,187.76 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,023.29 / $2,238.72
| Professional | | $660.69 | $1,023.29 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,513.56
| Professional | | $575.44 | $812.83 | $1,513.56 |