- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,981.07 / $8,912.51
| Facility | | $1,230.27 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,348.96 / $2,089.30
| Professional | | $1,174.90 | $1,348.96 | $2,089.30 |
- 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
- $1,548.82 / $2,041.74 / $9,549.93
| Professional | | $1,548.82 | $2,041.74 | $9,549.93 |
- 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 / $2,041.74 / $2,951.21
| Professional | | $1,548.82 | $2,041.74 | $2,951.21 |