- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,765.92 / $2,856.63 / $7,732.66
| Facility | | $1,765.92 | $2,856.63 | $7,732.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.78 / $1,453.51 / $1,647.31
| Professional | | $1,288.78 | $1,453.51 | $1,647.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.62 / $5,072.30 / $8,035.24
| Facility | | $1,335.62 | $5,072.30 | $8,035.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.63 / $1,849.64 / $8,959.19
| Professional | | $1,271.63 | $1,849.64 | $8,959.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.58 / $3,149.28 / $5,668.70
| Facility | | $1,294.58 | $3,149.28 | $5,668.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.47 / $1,938.01 / $3,538.25
| Facility | | $1,298.47 | $1,938.01 | $3,538.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $813.96 / $9,651.29
| Professional | | $813.96 | $813.96 | $9,651.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $813.96 / $1,162.81
| Professional | | $813.96 | $813.96 | $1,162.81 |