- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.40 / $1,889.38 / $6,087.42
| Facility | | $1,330.40 | $1,889.38 | $6,087.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,744.79 / $3,851.43 / $4,534.51
| Professional | | $3,744.79 | $3,851.43 | $4,534.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.55 / $2,183.30 / $3,440.25
| Facility | | $1,210.55 | $2,183.30 | $3,440.25 |
- 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 / $2,144.71 / $12,316.27
| Facility | | $1,360.28 | $2,144.71 | $12,316.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $670.79 / $1,565.17
| Professional | | $469.55 | $670.79 | $1,565.17 |