- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,481.66 / $4,212.99 / $8,758.79
| Facility | | $2,481.66 | $4,212.99 | $8,758.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.72 / $2,364.88 / $2,744.42
| Professional | | $2,043.72 | $2,364.88 | $2,744.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.94 / $4,284.51 / $11,386.44
| Facility | | $1,439.94 | $4,284.51 | $11,386.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,167.83 / $2,855.36
| Professional | | $1,167.83 | $1,167.83 | $2,855.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.60 / $4,896.17 / $8,539.83
| Facility | | $2,605.60 | $4,896.17 | $8,539.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.35 / $3,556.09 / $4,260.59
| Professional | | $3,388.35 | $3,556.09 | $4,260.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.76 / $2,773.62 / $3,503.52
| Facility | | $1,751.76 | $2,773.62 | $3,503.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $3,357.54
| Professional | | $1,226.23 | $1,751.76 | $3,357.54 |