- 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
- $1,839.06 / $2,043.65 / $4,360.08
| Facility | | $1,839.06 | $2,043.65 | $4,360.08 |
- 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 / $5,587.42
| Professional | | $1,743.95 | $2,531.17 | $5,587.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $670.79 / $1,117.98
| Professional | | $469.55 | $670.79 | $1,117.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.80 / $918.28 / $1,168.72
| Professional | | $834.80 | $918.28 | $1,168.72 |