- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,235.94 / $11,481.54
| Facility | | $2,344.23 | $3,235.94 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,778.28 / $2,884.03
| Professional | | $1,318.26 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $338.84 / $338.84
| Professional | | $229.09 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $16,982.44
| Facility | | $1,445.44 | $1,445.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $3,162.28
| Professional | | $2,570.40 | $2,570.40 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,995.26 / $2,238.72
| Facility | | $933.25 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $2,454.71
| Professional | | $891.25 | $1,122.02 | $2,454.71 |