- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.21 / $2,117.06 / $4,140.33
| Facility | | $1,272.21 | $2,117.06 | $4,140.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.33 / $1,245.63 / $1,367.15
| Professional | | $1,063.33 | $1,245.63 | $1,367.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.35 / $2,229.21 / $5,924.33
| Facility | | $445.35 | $2,229.21 | $5,924.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $277.42 / $1,519.06
| Professional | | $239.16 | $277.42 | $1,519.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.56 / $2,356.21 / $4,724.06
| Facility | | $1,169.56 | $2,356.21 | $4,724.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.06 / $1,850.06 / $2,216.58
| Professional | | $1,850.06 | $1,850.06 | $2,216.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.10 / $1,519.06 / $2,050.73
| Facility | | $1,443.10 | $1,519.06 | $2,050.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $911.44 / $1,746.92
| Professional | | $638.01 | $911.44 | $1,746.92 |