- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.01 / $2,313.25 / $5,556.91
| Facility | | $1,601.01 | $2,313.25 | $5,556.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.55 / $1,601.01 / $1,704.50
| Professional | | $1,290.55 | $1,601.01 | $1,704.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.48 / $3,573.36 / $6,026.63
| Facility | | $1,053.48 | $3,573.36 | $6,026.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.64 / $335.85 / $1,607.10
| Professional | | $237.64 | $335.85 | $1,607.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.75 / $6,751.27 / $13,975.15
| Facility | | $1,582.75 | $6,751.27 | $13,975.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,704.50 / $3,829.04 / $6,014.45
| Professional | | $1,704.50 | $3,829.04 | $6,014.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.09 / $1,560.35 / $4,273.18
| Professional | | $1,120.09 | $1,560.35 | $4,273.18 |