- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,469.31 / $3,994.47 / $10,812.70
| Facility | | $2,469.31 | $3,994.47 | $10,812.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.12 / $2,249.26 / $2,303.46
| Professional | | $1,802.12 | $2,249.26 | $2,303.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.35 / $5,340.88 / $8,460.70
| Facility | | $1,406.35 | $5,340.88 | $8,460.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.13 / $2,586.38 / $12,527.76
| Professional | | $1,778.13 | $2,586.38 | $12,527.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.30 / $4,403.68 / $7,926.62
| Facility | | $1,792.30 | $4,403.68 | $7,926.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.67 / $2,709.95 / $4,988.82
| Facility | | $1,815.67 | $2,709.95 | $4,988.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,138.18 / $13,495.55
| Professional | | $1,138.18 | $1,138.18 | $13,495.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,138.18 / $1,625.97
| Professional | | $1,138.18 | $1,138.18 | $1,625.97 |