- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,809.19 / $4,712.05 / $11,335.46
| Facility | | $2,809.19 | $4,712.05 | $11,335.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.68 / $2,256.79 / $5,675.82
| Professional | | $756.68 | $2,256.79 | $5,675.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.02 / $4,154.47 / $8,925.56
| Facility | | $2,423.02 | $4,154.47 | $8,925.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.59 / $1,982.36 / $4,917.43
| Professional | | $716.59 | $1,982.36 | $4,917.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.43 / $929.18 / $3,021.85
| Facility | | $353.43 | $929.18 | $3,021.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.61 / $6,324.33 / $6,324.33
| Professional | | $2,273.61 | $6,324.33 | $6,324.33 |