- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,311.31 / $8,709.64
| Facility | | $1,621.81 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,548.82 / $2,089.30
| Professional | | $1,258.93 | $1,548.82 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $9,120.11
| Facility | | $1,905.46 | $3,235.94 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,548.82 / $2,691.53
| Professional | | $154.88 | $1,548.82 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,630.78 / $8,511.38
| Facility | | $1,230.27 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $5,623.41
| Professional | | $2,187.76 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,905.46 / $2,290.87
| Facility | | $1,148.15 | $1,905.46 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $2,290.87
| Professional | | $794.33 | $1,148.15 | $2,290.87 |