- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,287.30 / $3,700.05 / $10,015.70
| Facility | | $2,287.30 | $3,700.05 | $10,015.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.29 / $1,882.66 / $2,133.67
| Professional | | $1,669.29 | $1,882.66 | $2,133.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.97 / $6,569.90 / $10,407.65
| Facility | | $1,729.97 | $6,569.90 | $10,407.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,647.07 / $2,395.73 / $11,604.39
| Professional | | $1,647.07 | $2,395.73 | $11,604.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.80 / $4,079.10 / $7,342.38
| Facility | | $1,676.80 | $4,079.10 | $7,342.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.84 / $2,510.21 / $4,621.26
| Facility | | $1,681.84 | $2,510.21 | $4,621.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,054.29 / $12,500.85
| Professional | | $1,054.29 | $1,054.29 | $12,500.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,054.29 / $1,506.13
| Professional | | $1,054.29 | $1,054.29 | $1,506.13 |