- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,872.55 / $3,910.45 / $14,253.80
| Facility | | $2,872.55 | $3,910.45 | $14,253.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.97 / $3,224.84 / $3,522.94
| Professional | | $1,625.97 | $3,224.84 | $3,522.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,934.33 / $5,292.26 / $8,339.06
| Facility | | $2,934.33 | $5,292.26 | $8,339.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.69 / $986.55 / $1,095.07
| Professional | | $902.69 | $986.55 | $1,095.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.95 / $2,709.95 / $2,709.95
| Facility | | $2,709.95 | $2,709.95 | $2,709.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.47 / $2,182.46 / $20,574.80
| Facility | | $1,761.47 | $2,182.46 | $20,574.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,354.98 / $3,387.44
| Professional | | $1,138.18 | $1,354.98 | $3,387.44 |