- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,073.80 / $5,248.07
| Facility | | $3,548.13 | $4,073.80 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,454.71 / $3,311.31
| Professional | | $2,344.23 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $891.25
| Facility | | $549.54 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $25.12 / $2,290.87
| Professional | | $17.38 | $25.12 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,884.03 / $7,585.78
| Facility | | $2,238.72 | $2,884.03 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,238.72 / $5,011.87
| Professional | | $1,584.89 | $2,238.72 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,162.28 / $3,548.13
| Facility | | $1,479.11 | $3,162.28 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,778.28 / $3,548.13
| Professional | | $1,479.11 | $1,778.28 | $3,548.13 |