- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.20 / $2,192.01 / $7,989.95
| Facility | | $1,610.20 | $2,192.01 | $7,989.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.44 / $1,807.68 / $1,974.78
| Professional | | $911.44 | $1,807.68 | $1,974.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.84 / $2,966.57 / $4,674.45
| Facility | | $1,644.84 | $2,966.57 | $4,674.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.06 / $1,519.06 / $1,519.06
| Facility | | $1,519.06 | $1,519.06 | $1,519.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.39 / $1,223.38 / $11,533.93
| Facility | | $987.39 | $1,223.38 | $11,533.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $817.91 / $2,126.67
| Professional | | $638.01 | $817.91 | $2,126.67 |