- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.06 / $1,976.96 / $6,369.57
| Facility | | $1,392.06 | $1,976.96 | $6,369.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,918.37 / $4,029.96 / $4,744.71
| Professional | | $3,918.37 | $4,029.96 | $4,744.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.66 / $2,284.50 / $3,599.71
| Facility | | $1,266.66 | $2,284.50 | $3,599.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.95 / $1,743.95 / $1,743.95
| Facility | | $1,743.95 | $1,743.95 | $1,743.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.28 / $2,244.46 / $12,316.27
| Facility | | $1,360.28 | $2,244.46 | $12,316.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.32 / $701.88 / $1,637.72
| Professional | | $491.32 | $701.88 | $1,637.72 |