- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,699.01 / $5,035.54 / $18,354.80
| Facility | | $3,699.01 | $5,035.54 | $18,354.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,093.78 / $4,152.66 / $4,536.52
| Professional | | $2,093.78 | $4,152.66 | $4,536.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $657.70 / $730.05
| Professional | | $597.91 | $657.70 | $730.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,489.63 / $3,489.63 / $3,489.63
| Facility | | $3,489.63 | $3,489.63 | $3,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.26 / $2,810.37 / $26,494.85
| Facility | | $2,268.26 | $2,810.37 | $26,494.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.64 / $2,093.78 / $5,234.45
| Professional | | $1,465.64 | $2,093.78 | $5,234.45 |