- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.49 / $3,606.50 / $8,074.63
| Facility | | $1,122.49 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.23 / $1,125.01 / $1,681.94
| Professional | | $930.23 | $1,125.01 | $1,681.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,306.06 / $13,456.16 / $24,482.41
| Facility | | $6,306.06 | $13,456.16 | $24,482.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.75 / $1,312.30 / $1,987.98
| Professional | | $993.75 | $1,312.30 | $1,987.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.58 / $1,134.58 / $1,568.99
| Facility | | $1,134.58 | $1,134.58 | $1,568.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.01 / $1,500.49 / $2,450.71
| Professional | | $1,032.01 | $1,500.49 | $2,450.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.26 / $1,375.47 / $2,293.96
| Professional | | $970.26 | $1,375.47 | $2,293.96 |