- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.22 / $4,291.85 / $12,207.60
| Facility | | $1,953.22 | $4,291.85 | $12,207.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.60 / $2,138.71 / $4,562.88
| Facility | | $1,924.60 | $2,138.71 | $4,562.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.58 / $1,133.56 / $1,133.57
| Professional | | $697.58 | $1,133.56 | $1,133.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,149.06 / $6,375.40 / $7,650.46
| Facility | | $3,149.06 | $6,375.40 | $7,650.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.95 / $2,531.17 / $5,744.75
| Professional | | $1,743.95 | $2,531.17 | $5,744.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.32 / $701.88 / $1,169.80
| Professional | | $491.32 | $701.88 | $1,169.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.49 / $960.84 / $1,222.89
| Professional | | $873.49 | $960.84 | $1,222.89 |