- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.90 / $1,446.51 / $1,720.67
| Facility | | $1,433.90 | $1,446.51 | $1,720.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.90 / $1,591.16 / $1,636.77
| Professional | | $1,433.90 | $1,591.16 | $1,636.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,023.98 / $12,023.98 / $13,082.09
| Facility | | $12,023.98 | $12,023.98 | $13,082.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.23 / $716.34 / $795.93
| Professional | | $541.23 | $716.34 | $795.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.13 / $7,040.60 / $18,397.88
| Facility | | $1,114.13 | $7,040.60 | $18,397.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.53 / $1,126.69 / $2,090.51
| Professional | | $590.53 | $1,126.69 | $2,090.51 |