- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,715.35 / $9,549.93
| Facility | | $1,047.13 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $1,905.46
| Professional | | $660.69 | $776.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,760.83 / $20,417.38
| Facility | | $2,511.89 | $6,760.83 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,023.29 / $1,862.09
| Professional | | $660.69 | $1,023.29 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,290.87 / $6,456.54
| Facility | | $1,288.25 | $2,290.87 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $2,344.23
| Professional | | $741.31 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,621.81
| Professional | | $616.60 | $891.25 | $1,621.81 |