- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $10,715.19
| Facility | | $3,890.45 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,862.09
| Professional | | $831.76 | $1,122.02 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,884.03 / $8,709.64
| Facility | | $2,630.27 | $2,884.03 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $977.24 / $1,445.44
| Professional | | $239.88 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,786.30 / $6,606.93
| Facility | | $2,454.71 | $4,786.30 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,884.03
| Professional | | $1,513.56 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,513.56
| Professional | | $912.01 | $912.01 | $1,513.56 |