- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,466.84 / $10,964.78
| Facility | | $1,202.26 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $2,238.72
| Professional | | $812.83 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $14,791.08
| Facility | | $2,754.23 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,047.13 / $2,187.76
| Professional | | $724.44 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,630.27 / $7,244.36
| Facility | | $851.14 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,288.25 / $3,162.28
| Professional | | $758.58 | $1,288.25 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $12,589.25
| Facility | | $1,819.70 | $5,495.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $977.24 / $1,905.46
| Professional | | $707.95 | $977.24 | $1,905.46 |