- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.77 / $3,068.10 / $11,183.40
| Facility | | $2,253.77 | $3,068.10 | $11,183.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.72 / $2,530.17 / $2,764.06
| Professional | | $1,275.72 | $2,530.17 | $2,764.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,302.25 / $4,152.26 / $6,542.74
| Facility | | $2,302.25 | $4,152.26 | $6,542.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.45 / $92.30 / $128.37
| Professional | | $84.45 | $92.30 | $128.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.19 / $2,126.19 / $2,126.19
| Facility | | $2,126.19 | $2,126.19 | $2,126.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.03 / $1,712.34 / $16,141.84
| Facility | | $1,382.03 | $1,712.34 | $16,141.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.43 / $1,275.72 / $2,126.19
| Facility | | $765.43 | $1,275.72 | $2,126.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.00 / $1,063.09 / $2,764.06
| Professional | | $893.00 | $1,063.09 | $2,764.06 |