- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $7,762.47
| Facility | | $1,513.56 | $1,548.82 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $2,290.87
| Professional | | $831.76 | $1,047.13 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,348.96 / $1,862.09
| Professional | | $776.25 | $1,348.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,380.38
| Professional | | $32.36 | $33.11 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $1,862.09
| Facility | | $954.99 | $1,258.93 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $1,862.09
| Professional | | $776.25 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $19,498.45
| Facility | | $3,090.30 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,318.26 / $2,137.96
| Professional | | $954.99 | $1,318.26 | $2,137.96 |