- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,365.16 / $10,964.78
| Facility | | $1,230.27 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,096.48 / $2,290.87
| Professional | | $870.96 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,309.57 / $12,302.69
| Facility | | $2,398.83 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,238.72
| Professional | | $812.83 | $1,148.15 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,344.23 / $7,244.36
| Facility | | $812.83 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,380.38 / $3,162.28
| Professional | | $812.83 | $1,380.38 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,288.25 / $4,168.69
| Facility | | $269.15 | $1,288.25 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,995.26
| Professional | | $776.25 | $1,047.13 | $1,995.26 |