- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,951.21 / $3,890.45
| Facility | | $1,479.11 | $2,951.21 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $4,168.69
| Professional | | $1,737.80 | $2,951.21 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $3,019.95
| Facility | | $512.86 | $645.65 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,981.07 / $5,888.44
| Professional | | $1,995.26 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $64.57 / $38,904.51
| Facility | | $9.77 | $64.57 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $7,585.78
| Professional | | $251.19 | $251.19 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $380.19 / $3,090.30
| Facility | | $177.83 | $380.19 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $2,454.71
| Professional | | $190.55 | $269.15 | $2,454.71 |