- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,623.41 / $8,317.64
| Facility | | $3,467.37 | $5,623.41 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,122.02 / $1,905.46
| Professional | | $954.99 | $1,122.02 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,025.60
| Facility | | $1,230.27 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $2,187.76
| Professional | | $1,096.48 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $2,511.89
| Facility | | $501.19 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $2,754.23
| Professional | | $1,071.52 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $8,511.38
| Professional | | $1,202.26 | $1,819.70 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,479.11 / $2,691.53
| Professional | | $891.25 | $1,479.11 | $2,691.53 |