- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,352.28 / $3,202.20 / $11,672.20
| Facility | | $2,352.28 | $3,202.20 | $11,672.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.35 / $2,463.23 / $2,884.87
| Professional | | $1,664.35 | $2,463.23 | $2,884.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $277.76 / $339.20
| Professional | | $3.93 | $277.76 | $339.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.43 / $15,674.17 / $16,849.37
| Facility | | $1,442.43 | $15,674.17 | $16,849.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.86 / $2,549.86 / $3,187.33
| Professional | | $2,549.86 | $2,549.86 | $3,187.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.65 / $1,109.57 / $3,328.70
| Professional | | $887.65 | $1,109.57 | $3,328.70 |