- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,041.74 / $9,120.11
| Facility | | $1,949.84 | $2,041.74 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,778.28
| Professional | | $912.01 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,388.44 / $3,630.78
| Facility | | $1,513.56 | $3,388.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,995.26 / $3,311.31
| Professional | | $1,621.81 | $1,995.26 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $10,471.29 / $25,703.96
| Facility | | $134.90 | $10,471.29 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,548.82
| Professional | | $1,230.27 | $1,230.27 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,548.82 / $3,162.28
| Facility | | $724.44 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,621.81
| Professional | | $616.60 | $912.01 | $1,621.81 |