- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $7,762.47
| Facility | | $2,089.30 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $4,365.16 / $7,244.36
| Professional | | $616.60 | $4,365.16 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,981.07 / $5,888.44
| Facility | | $1,230.27 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $676.08 / $2,089.30
| Professional | | $645.65 | $676.08 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $10,471.29 / $20,417.38
| Facility | | $707.95 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $707.95 / $12,022.64
| Professional | | $380.19 | $707.95 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $10,471.29 / $17,378.01
| Facility | | $4,570.88 | $10,471.29 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $691.83 / $9,772.37
| Professional | | $380.19 | $691.83 | $9,772.37 |