- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,495.41 / $7,762.47
| Facility | | $1,071.52 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $2,884.03
| Professional | | $954.99 | $1,047.13 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,715.35 / $10,715.19
| Professional | | $1,023.29 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $2,884.03
| Professional | | $1,023.29 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,089.30 / $2,398.83
| Professional | | $977.24 | $2,089.30 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,218.10 / $35,481.34
| Facility | | $4,073.80 | $16,218.10 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,380.38 / $2,884.03
| Professional | | $851.14 | $1,380.38 | $2,884.03 |