- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.41 / $1,837.83 / $3,898.67
| Facility | | $1,154.41 | $1,837.83 | $3,898.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.11 / $1,080.15 / $1,350.19
| Professional | | $810.11 | $1,080.15 | $1,350.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.58 / $1,491.96 / $4,671.66
| Facility | | $1,306.58 | $1,491.96 | $4,671.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.08 / $699.39 / $1,566.22
| Professional | | $540.08 | $699.39 | $1,566.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.62 / $2,226.96 / $3,725.06
| Facility | | $930.62 | $2,226.96 | $3,725.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.86 / $1,551.64 / $2,234.28
| Professional | | $789.86 | $1,551.64 | $2,234.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $1,850.00 / $1,850.00
| Facility | | $1,850.00 | $1,850.00 | $1,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.08 / $810.11 / $1,527.06
| Professional | | $567.08 | $810.11 | $1,527.06 |