- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,365.16 / $10,964.78
| Facility | | $1,348.96 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,348.96 / $2,754.23
| Professional | | $1,023.29 | $1,348.96 | $2,754.23 |
- 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
- $954.99 / $1,348.96 / $2,818.38
| Professional | | $954.99 | $1,348.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,090.30 / $9,120.11
| Facility | | $851.14 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $3,981.07
| Professional | | $977.24 | $1,659.59 | $3,981.07 |
- 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
- $912.01 / $1,258.93 / $2,454.71
| Professional | | $912.01 | $1,258.93 | $2,454.71 |