- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.42 / $1,442.54 / $7,662.23
| Professional | | $1,007.42 | $1,442.54 | $7,662.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,671.43 / $21,503.38 / $23,906.61
| Facility | | $16,671.43 | $21,503.38 | $23,906.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,074.00 / $7,819.00 / $19,195.00
| Facility | | $5,074.00 | $7,819.00 | $19,195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.44 / $1,505.55 / $5,356.94
| Professional | | $992.44 | $1,505.55 | $5,356.94 |