- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.11 / $1,341.76 / $4,753.71
| Facility | | $1,032.11 | $1,341.76 | $4,753.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.20 / $1,088.16 / $1,174.92
| Professional | | $1,003.20 | $1,088.16 | $1,174.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.59 / $233.80 / $2,072.66
| Facility | | $67.59 | $233.80 | $2,072.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.51 / $716.26 / $1,450.34
| Professional | | $577.51 | $716.26 | $1,450.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.57 / $2,358.84 / $5,258.25
| Facility | | $967.57 | $2,358.84 | $5,258.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.61 / $544.94 / $1,693.30
| Professional | | $513.61 | $544.94 | $1,693.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.59 / $567.05 / $1,440.80
| Professional | | $379.59 | $567.05 | $1,440.80 |