- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,630.27 / $6,606.93
| Facility | | $1,288.25 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,041.74 / $7,943.28
| Professional | | $1,737.80 | $2,041.74 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,949.84 / $9,332.54
| Facility | | $501.19 | $1,949.84 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,479.11 / $44,668.36
| Professional | | $977.24 | $1,479.11 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,258.93 / $2,238.72
| Professional | | $977.24 | $1,258.93 | $2,238.72 |