- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.39 / $2,550.17 / $4,401.04
| Facility | | $1,650.39 | $2,550.17 | $4,401.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.72 / $1,631.42 / $1,840.09
| Professional | | $1,441.72 | $1,631.42 | $1,840.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.20 / $1,688.28 / $3,383.32
| Professional | | $1,138.20 | $1,688.28 | $3,383.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,612.83 / $3,663.39 / $4,521.59
| Facility | | $2,612.83 | $3,663.39 | $4,521.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,202.03 / $2,202.03 / $2,202.03
| Professional | | $2,202.03 | $2,202.03 | $2,202.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.45 / $2,276.40 / $9,010.75
| Facility | | $1,612.45 | $2,276.40 | $9,010.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.74 / $1,138.20 / $9,447.06
| Professional | | $796.74 | $1,138.20 | $9,447.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.74 / $1,138.20 / $2,276.40
| Professional | | $796.74 | $1,138.20 | $2,276.40 |