- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.54 / $3,251.21 / $4,835.04
| Facility | | $1,651.54 | $3,251.21 | $4,835.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.87 / $1,094.07 / $1,579.61
| Professional | | $971.87 | $1,094.07 | $1,579.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.85 / $1,278.68 / $2,066.79
| Professional | | $923.85 | $1,278.68 | $2,066.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.96 / $1,741.28 / $2,212.17
| Professional | | $1,331.96 | $1,741.28 | $2,212.17 |
- 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
- $928.45 / $1,533.40 / $2,344.52
| Professional | | $928.45 | $1,533.40 | $2,344.52 |