- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,365.16 / $9,120.11
| Facility | | $3,019.95 | $4,365.16 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,137.96 / $2,951.21
| Professional | | $1,659.59 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,011.87 / $8,128.31
| Facility | | $3,801.89 | $5,011.87 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,019.95 / $5,754.40
| Professional | | $1,548.82 | $3,019.95 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $10,471.29 / $15,135.61
| Facility | | $1,949.84 | $10,471.29 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,623.41 / $6,606.93
| Professional | | $4,073.80 | $5,623.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,819.70 / $5,370.32
| Professional | | $1,445.44 | $1,819.70 | $5,370.32 |