- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,466.84 / $5,370.32
| Facility | | $3,630.78 | $4,466.84 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $3,801.89
| Professional | | $2,137.96 | $2,951.21 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $70.79 / $95.50
| Facility | | $58.88 | $70.79 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,311.31 / $8,511.38
| Facility | | $2,884.03 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,548.13 / $3,890.45
| Facility | | $1,659.59 | $3,548.13 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $2,344.23
| Professional | | $1,659.59 | $1,659.59 | $2,344.23 |