- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,981.07 / $10,471.29
| Facility | | $1,949.84 | $3,981.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $2,187.76
| Professional | | $1,412.54 | $1,778.28 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,890.45 / $11,481.54
| Facility | | $1,905.46 | $3,890.45 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $2,818.38
| Professional | | $794.33 | $977.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,365.16 / $10,232.93
| Facility | | $1,479.11 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $6,309.57
| Professional | | $2,630.27 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,290.87 / $2,754.23
| Facility | | $1,380.38 | $2,290.87 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,754.23
| Professional | | $954.99 | $1,380.38 | $2,754.23 |