- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,466.84 / $10,964.78
| Facility | | $1,230.27 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $2,454.71
| Professional | | $977.24 | $1,230.27 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,302.69
| Facility | | $2,454.71 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,511.89
| Professional | | $891.25 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,290.87 / $7,943.28
| Facility | | $977.24 | $2,290.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,513.56 / $3,548.13
| Professional | | $891.25 | $1,513.56 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,606.93 / $15,135.61
| Facility | | $1,949.84 | $6,606.93 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,174.90 / $2,238.72
| Professional | | $851.14 | $1,174.90 | $2,238.72 |