- 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
- $616.60 / $870.96 / $1,819.70
| Professional | | $616.60 | $870.96 | $1,819.70 |
- 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
- $630.96 / $933.25 / $1,905.46
| Professional | | $630.96 | $933.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,187.76 / $6,760.83
| Facility | | $812.83 | $2,187.76 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $2,754.23
| Professional | | $691.83 | $1,096.48 | $2,754.23 |
- 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
- $602.56 / $870.96 / $1,737.80
| Professional | | $602.56 | $870.96 | $1,737.80 |