- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $8,317.64
| Facility | | $1,819.70 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $1,862.09
| Professional | | $1,096.48 | $1,412.54 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $5,623.41
| Facility | | $912.01 | $1,412.54 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $10,715.19
| Professional | | $1,445.44 | $1,778.28 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,230.27 / $8,128.31
| Facility | | $478.63 | $1,230.27 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,698.24 / $2,454.71
| Professional | | $1,445.44 | $1,698.24 | $2,454.71 |