- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,981.07 / $8,912.51
| Facility | | $1,380.38 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,995.26 / $2,570.40
| Professional | | $1,548.82 | $1,995.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $15,848.93
| Facility | | $5,495.41 | $5,495.41 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,737.80 / $8,128.31
| Facility | | $501.19 | $1,737.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,238.72 / $16,218.10
| Professional | | $1,584.89 | $2,238.72 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,137.96 / $3,090.30
| Professional | | $1,548.82 | $2,137.96 | $3,090.30 |