- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,041.74 / $4,786.30
| Facility | | $1,122.02 | $2,041.74 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,230.27
| Professional | | $741.31 | $1,047.13 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $3,890.45
| Facility | | $1,318.26 | $1,318.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $288.40 / $602.56
| Professional | | $245.47 | $288.40 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $19,054.61 / $28,183.83
| Facility | | $1,258.93 | $19,054.61 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,584.89 / $3,890.45
| Professional | | $380.19 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,318.26 / $1,318.26
| Facility | | $1,122.02 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,230.27
| Professional | | $467.74 | $676.08 | $1,230.27 |