- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,041.74 / $2,818.38
| Facility | | $1,071.52 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $1,513.56
| Professional | | $977.24 | $1,230.27 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $10,232.93
| Facility | | $7,413.10 | $7,413.10 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,584.89 / $2,630.27
| Professional | | $630.96 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,888.44 / $14,454.40
| Facility | | $2,187.76 | $5,888.44 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $2,238.72
| Professional | | $776.25 | $1,202.26 | $2,238.72 |