- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,011.87 / $9,772.37
| Facility | | $2,238.72 | $5,011.87 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $2,290.87 / $8,317.64
| Professional | | $245.47 | $2,290.87 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,344.23 / $4,265.80
| Facility | | $891.25 | $2,344.23 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $1,548.82
| Professional | | $741.31 | $954.99 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,606.93 / $8,912.51
| Facility | | $2,344.23 | $6,606.93 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,495.41 / $8,709.64
| Facility | | $3,548.13 | $5,495.41 | $8,709.64 |