- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,677.35 / $7,762.47
| Facility | | $2,041.74 | $4,677.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,047.13 / $2,238.72
| Professional | | $870.96 | $1,047.13 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $954.99 / $2,884.03
| Professional | | $912.01 | $954.99 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $1,548.82
| Professional | | $891.25 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,698.24 / $5,128.61
| Facility | | $954.99 | $1,698.24 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,096.48 / $6,606.93
| Professional | | $851.14 | $1,096.48 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,290.87 / $5,495.41
| Facility | | $1,348.96 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,621.81
| Professional | | $831.76 | $1,023.29 | $1,621.81 |