- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $7,762.47
| Facility | | $1,380.38 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,380.38 / $3,548.13
| Professional | | $741.31 | $1,380.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $1,737.80
| Professional | | $1,288.25 | $1,584.89 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,884.03
| Professional | | $1,047.13 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,454.71
| Professional | | $2,290.87 | $2,290.87 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $16,218.10
| Facility | | $645.65 | $2,344.23 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $3,162.28
| Professional | | $1,071.52 | $1,621.81 | $3,162.28 |