- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $12,882.50
| Facility | | $1,047.13 | $4,786.30 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $891.25 / $1,096.48
| Professional | | $741.31 | $891.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,584.89 / $1,995.26
| Professional | | $1,230.27 | $1,584.89 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,288.25 / $1,949.84
| Facility | | $851.14 | $1,288.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $11,481.54
| Facility | | $794.33 | $1,174.90 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,882.50 / $29,512.09
| Facility | | $7,762.47 | $12,882.50 | $29,512.09 |