- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,025.60 / $16,595.87
| Facility | | $2,818.38 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $1,905.46
| Professional | | $912.01 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $7,079.46
| Facility | | $1,621.81 | $3,890.45 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,288.25 / $1,905.46
| Professional | | $933.25 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,949.84
| Facility | | $1,513.56 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,380.38 / $2,290.87
| Professional | | $1,071.52 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $2,454.71
| Facility | | $1,023.29 | $1,412.54 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,471.29
| Facility | | $1,698.24 | $6,760.83 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $2,137.96
| Professional | | $933.25 | $1,230.27 | $2,137.96 |