- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.42 / $3,489.63 / $7,963.68
| Facility | | $2,294.42 | $3,489.63 | $7,963.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.50 / $2,294.42 / $2,442.73
| Professional | | $1,849.50 | $2,294.42 | $2,442.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.32 / $5,121.03 / $8,636.83
| Facility | | $216.32 | $5,121.03 | $8,636.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.17 / $935.78 / $2,303.15
| Professional | | $720.17 | $935.78 | $2,303.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.26 / $11,223.96 / $20,028.65
| Facility | | $2,268.26 | $11,223.96 | $20,028.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.73 / $5,487.45 / $8,619.39
| Professional | | $2,442.73 | $5,487.45 | $8,619.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,605.23 / $2,093.78 / $6,123.95
| Professional | | $1,605.23 | $2,093.78 | $6,123.95 |