- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.80 / $2,804.05 / $10,220.90
| Facility | | $2,059.80 | $2,804.05 | $10,220.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.93 / $2,312.42 / $2,526.17
| Professional | | $1,165.93 | $2,312.42 | $2,526.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.11 / $3,794.89 / $5,979.65
| Facility | | $2,104.11 | $3,794.89 | $5,979.65 |
- 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
- $1,943.21 / $1,943.21 / $1,943.21
| Facility | | $1,943.21 | $1,943.21 | $1,943.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.08 / $1,564.97 / $14,752.52
| Facility | | $1,263.08 | $1,564.97 | $14,752.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $971.61 / $2,429.01
| Professional | | $816.15 | $971.61 | $2,429.01 |