- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,981.07 / $8,912.51
| Facility | | $1,318.26 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $1,737.80
| Professional | | $933.25 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,715.19 / $17,782.79
| Facility | | $6,918.31 | $10,715.19 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,621.81 / $1,819.70
| Professional | | $1,122.02 | $1,621.81 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,737.80 / $7,244.36
| Facility | | $346.74 | $1,737.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $7,585.78
| Professional | | $954.99 | $1,258.93 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $1,819.70
| Professional | | $912.01 | $1,258.93 | $1,819.70 |