- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,094.78 / $4,212.99 / $15,356.50
| Facility | | $3,094.78 | $4,212.99 | $15,356.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.76 / $3,474.32 / $3,795.48
| Professional | | $1,751.76 | $3,474.32 | $3,795.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,161.34 / $5,701.69 / $8,984.19
| Facility | | $3,161.34 | $5,701.69 | $8,984.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $657.70 / $730.05
| Professional | | $597.91 | $657.70 | $730.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $2,919.60
| Facility | | $2,919.60 | $2,919.60 | $2,919.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.74 / $2,351.30 / $22,167.38
| Facility | | $1,897.74 | $2,351.30 | $22,167.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,459.80 / $4,087.44
| Professional | | $1,226.23 | $1,459.80 | $4,087.44 |