- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,570.88 / $10,471.29
| Facility | | $1,949.84 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $2,089.30
| Professional | | $870.96 | $1,023.29 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,412.54 / $1,412.54
| Facility | | $1,318.26 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,548.82 / $6,918.31
| Facility | | $977.24 | $1,548.82 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $7,079.46
| Professional | | $933.25 | $1,174.90 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,818.38 / $6,309.57
| Facility | | $1,862.09 | $2,818.38 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,096.48 / $1,548.82
| Professional | | $912.01 | $1,096.48 | $1,548.82 |