- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,466.84 / $11,748.98
| Facility | | $2,187.76 | $4,466.84 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,041.74 / $2,570.40
| Professional | | $1,584.89 | $2,041.74 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,897.79 / $12,302.69
| Facility | | $2,570.40 | $4,897.79 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,786.30 / $7,413.10
| Professional | | $2,290.87 | $4,786.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,265.80 / $10,964.78
| Facility | | $1,659.59 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,715.35 / $7,079.46
| Professional | | $3,019.95 | $3,715.35 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,570.40 / $3,090.30
| Facility | | $1,548.82 | $2,570.40 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,548.82 / $3,090.30
| Professional | | $1,071.52 | $1,548.82 | $3,090.30 |