- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,073.80 / $7,762.47
| Facility | | $1,071.52 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,047.13 / $2,344.23
| Professional | | $645.65 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $2,818.38 / $6,456.54
| Professional | | $776.25 | $2,818.38 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $2,344.23
| Professional | | $812.83 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $870.96 / $2,041.74
| Professional | | $831.76 | $870.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $12,882.50 / $26,915.35
| Facility | | $3,311.31 | $12,882.50 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $2,290.87
| Professional | | $741.31 | $1,047.13 | $2,290.87 |