- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,011.87 / $9,772.37
| Facility | | $2,238.72 | $5,011.87 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,801.89 / $5,128.61
| Professional | | $2,398.83 | $3,801.89 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,884.03 / $4,265.80
| Facility | | $891.25 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,288.25 / $3,630.78
| Professional | | $1,148.15 | $1,288.25 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,760.83 / $10,232.93
| Facility | | $4,786.30 | $6,760.83 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,888.44 / $8,709.64
| Facility | | $4,168.69 | $5,888.44 | $8,709.64 |