- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,398.83
| Facility | | $1,258.93 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,819.70 / $4,168.69
| Professional | | $645.65 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,748.98 / $15,848.93
| Facility | | $9,772.37 | $11,748.98 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,905.46 / $3,467.37
| Professional | | $741.31 | $1,905.46 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,137.96 / $5,623.41
| Professional | | $660.69 | $2,137.96 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,019.95 / $4,365.16
| Facility | | $831.76 | $3,019.95 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,073.80
| Professional | | $575.44 | $1,949.84 | $4,073.80 |