- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,773.94 / $2,432.02 / $2,546.46
| Facility | | $1,773.94 | $2,432.02 | $2,546.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,773.94 / $2,090.91 / $2,546.46
| Professional | | $1,773.94 | $2,090.91 | $2,546.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.29 / $558.29 / $614.12
| Facility | | $558.29 | $558.29 | $614.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.82 / $326.82 / $326.82
| Professional | | $326.82 | $326.82 | $326.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.19 / $2,095.19 / $2,576.44
| Facility | | $2,095.19 | $2,095.19 | $2,576.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.51 / $1,472.88 / $2,147.58
| Professional | | $192.51 | $1,472.88 | $2,147.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $268.45 / $2,281.90
| Professional | | $95.50 | $268.45 | $2,281.90 |