- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $6,456.54
| Facility | | $1,698.24 | $2,511.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,128.61 / $7,943.28
| Professional | | $4,466.84 | $5,128.61 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $537.03 / $562.34
| Facility | | $512.86 | $537.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,606.93 / $8,912.51
| Professional | | $3,090.30 | $6,606.93 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $2,570.40
| Facility | | $371.54 | $758.58 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $9,120.11
| Professional | | $3,467.37 | $5,495.41 | $9,120.11 |