- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $10,471.29
| Facility | | $1,949.84 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,096.48 / $2,454.71
| Professional | | $891.25 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $741.31 / $1,122.02
| Professional | | $371.54 | $741.31 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,659.59 / $7,413.10
| Facility | | $912.01 | $1,659.59 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,778.28 / $9,332.54
| Professional | | $1,174.90 | $1,778.28 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,122.02 / $5,128.61
| Facility | | $602.56 | $1,122.02 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,778.28 / $8,912.51
| Professional | | $1,174.90 | $1,778.28 | $8,912.51 |