- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $2,454.71
| Facility | | $1,230.27 | $2,137.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,348.96
| Professional | | $831.76 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $776.25 / $2,089.30
| Professional | | $66.07 | $776.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,454.71 / $3,019.95
| Facility | | $1,659.59 | $2,454.71 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,513.56 / $6,025.60
| Facility | | $1,096.48 | $1,513.56 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $6,309.57
| Professional | | $524.81 | $758.58 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,258.93 / $1,513.56
| Facility | | $524.81 | $1,258.93 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,380.38
| Professional | | $524.81 | $758.58 | $1,380.38 |