- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,238.72 / $3,235.94
| Facility | | $2,089.30 | $2,238.72 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,096.48 / $9,332.54
| Professional | | $954.99 | $1,096.48 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $1,659.59
| Facility | | $363.08 | $645.65 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.76 / $1,445.44 / $5,011.87
| Facility | | $0.76 | $1,445.44 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,862.09 / $3,715.35
| Facility | | $616.60 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |