- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $7,462.29
| Facility | | $2,090.73 | $3,706.14 | $7,462.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.78 / $1,144.72 / $1,334.93
| Professional | | $815.78 | $1,144.72 | $1,334.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.04 / $1,074.10 / $1,711.82
| Professional | | $776.04 | $1,074.10 | $1,711.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.85 / $1,434.72 / $1,848.23
| Professional | | $1,118.85 | $1,434.72 | $1,848.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,713.00 / $7,457.00 / $12,945.00
| Facility | | $3,713.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.87 / $1,117.39 / $1,833.27
| Professional | | $734.87 | $1,117.39 | $1,833.27 |