- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,570.40 / $7,762.47
| Facility | | $1,949.84 | $2,570.40 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,995.26 / $2,951.21
| Professional | | $1,819.70 | $1,995.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $6,918.31
| Facility | | $1,659.59 | $1,659.59 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,715.35
| Professional | | $3,162.28 | $3,162.28 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,570.40 / $4,466.84
| Facility | | $1,905.46 | $2,570.40 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $9,772.37
| Professional | | $1,071.52 | $1,071.52 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,570.40 / $3,090.30
| Facility | | $1,071.52 | $2,570.40 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,698.24
| Professional | | $1,071.52 | $1,071.52 | $1,698.24 |