- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,754.40 / $10,471.29
| Facility | | $2,754.23 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $1,995.26
| Professional | | $602.56 | $776.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $1,778.28
| Professional | | $537.03 | $891.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,380.38
| Professional | | $912.01 | $1,230.27 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,888.44 / $9,549.93
| Facility | | $4,073.80 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $977.24 / $1,584.89
| Professional | | $575.44 | $977.24 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $8,709.64
| Facility | | $2,570.40 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $660.69 / $1,445.44
| Professional | | $398.11 | $660.69 | $1,445.44 |