- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $5,370.32
| Facility | | $1,905.46 | $1,905.46 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $660.69
| Professional | | $416.87 | $562.34 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,479.11 / $4,365.16
| Facility | | $1,318.26 | $1,479.11 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $489.78 / $724.44
| Professional | | $302.00 | $489.78 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,398.83 / $3,311.31
| Facility | | $1,230.27 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,445.44
| Professional | | $758.58 | $758.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $794.33
| Professional | | $457.09 | $457.09 | $794.33 |