- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,370.32 / $9,549.93
| Facility | | $1,949.84 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $933.25 / $2,290.87
| Professional | | $338.84 | $933.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $707.95 / $954.99
| Professional | | $436.52 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $870.96 / $2,290.87
| Professional | | $457.09 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,905.46
| Professional | | $1,412.54 | $1,412.54 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $831.76 / $2,041.74
| Professional | | $354.81 | $831.76 | $2,041.74 |