- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.83 / $1,958.05 / $3,585.84
| Facility | | $1,174.83 | $1,958.05 | $3,585.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.76 / $1,044.30 / $1,135.67
| Professional | | $913.76 | $1,044.30 | $1,135.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.86 / $1,915.63 / $5,090.93
| Facility | | $422.86 | $1,915.63 | $5,090.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.36 / $233.57 / $1,172.22
| Professional | | $201.36 | $233.57 | $1,172.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.01 / $2,024.90 / $4,006.45
| Facility | | $933.01 | $2,024.90 | $4,006.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.72 / $1,566.44 / $1,729.74
| Professional | | $1,443.72 | $1,566.44 | $1,729.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.09 / $1,240.09 / $1,566.44
| Facility | | $1,240.09 | $1,240.09 | $1,566.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,696.98
| Professional | | $548.26 | $783.22 | $1,696.98 |