- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.25 / $3,172.22 / $11,562.90
| Facility | | $2,330.25 | $3,172.22 | $11,562.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.01 / $2,616.04 / $2,857.86
| Professional | | $1,319.01 | $2,616.04 | $2,857.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.37 / $4,293.16 / $6,764.76
| Facility | | $2,380.37 | $4,293.16 | $6,764.76 |
- 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
- $2,198.35 / $2,198.35 / $2,198.35
| Facility | | $2,198.35 | $2,198.35 | $2,198.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.93 / $1,770.44 / $16,689.84
| Facility | | $1,428.93 | $1,770.44 | $16,689.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.31 / $1,319.01 / $3,077.69
| Professional | | $923.31 | $1,319.01 | $3,077.69 |