- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $7,762.47 / $8,709.64
| Facility | | $1,548.82 | $7,762.47 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,248.07 / $5,754.40
| Professional | | $1,148.15 | $5,248.07 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $85.11 / $6,309.57
| Professional | | $60.26 | $85.11 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $12,022.64
| Facility | | $3,467.37 | $3,467.37 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $21,379.62 / $50,118.72
| Facility | | $1,659.59 | $21,379.62 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,344.23
| Professional | | $933.25 | $1,318.26 | $2,344.23 |