- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,762.47 / $8,709.64
| Facility | | $2,089.30 | $7,762.47 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $1,412.54
| Professional | | $1,023.29 | $1,380.38 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $85.11
| Professional | | $50.12 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,380.38 / $2,137.96
| Facility | | $1,202.26 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $15,135.61 / $56,234.13
| Facility | | $1,023.29 | $15,135.61 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $2,818.38
| Professional | | $1,412.54 | $1,995.26 | $2,818.38 |