- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.82 / $2,375.42 / $3,891.66
| Facility | | $1,010.82 | $2,375.42 | $3,891.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.47 / $1,010.82 / $1,036.08
| Professional | | $884.47 | $1,010.82 | $1,036.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.38 / $79.65 / $1,640.06
| Professional | | $66.38 | $79.65 | $1,640.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.53 / $3,695.83 / $36,321.57
| Facility | | $1,263.53 | $3,695.83 | $36,321.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.78 / $3,032.47 / $29,717.64
| Professional | | $1,320.78 | $3,032.47 | $29,717.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.26 / $2,660.98 / $8,518.50
| Facility | | $1,437.26 | $2,660.98 | $8,518.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.26 / $2,660.98 / $8,518.50
| Facility | | $1,437.26 | $2,660.98 | $8,518.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.67 / $758.12 / $1,668.74
| Professional | | $530.67 | $758.12 | $1,668.74 |