- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,370.32 / $9,549.93
| Facility | | $1,513.56 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,380.38 / $2,754.23
| Professional | | $407.38 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,570.88 / $6,918.31
| Facility | | $1,698.24 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,778.28 / $4,168.69
| Professional | | $616.60 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,244.36 / $9,772.37
| Facility | | $4,168.69 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,412.54 / $3,801.89
| Professional | | $501.19 | $1,412.54 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,621.81 / $3,019.95
| Professional | | $416.87 | $1,621.81 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,918.31 / $12,022.64
| Facility | | $1,737.80 | $6,918.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,737.80 / $3,467.37
| Professional | | $467.74 | $1,737.80 | $3,467.37 |