- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,715.35 / $9,772.37
| Facility | | $1,148.15 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $2,818.38
| Professional | | $891.25 | $1,122.02 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,309.57 / $14,125.38
| Facility | | $2,344.23 | $6,309.57 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,318.26 / $2,511.89
| Professional | | $851.14 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,454.71 / $7,079.46
| Facility | | $1,174.90 | $2,454.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,479.11 / $3,162.28
| Professional | | $954.99 | $1,479.11 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $17,378.01
| Facility | | $2,454.71 | $7,244.36 | $17,378.01 |
- 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 |