- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.62 / $3,746.30 / $9,769.75
| Facility | | $1,886.62 | $3,746.30 | $9,769.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.29 / $1,836.42 / $2,081.28
| Professional | | $1,628.29 | $1,836.42 | $2,081.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,687.48 / $6,408.54 / $10,152.02
| Facility | | $1,687.48 | $6,408.54 | $10,152.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.62 / $2,336.90 / $11,319.38
| Professional | | $1,606.62 | $2,336.90 | $11,319.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.18 / $3,819.74 / $6,843.71
| Facility | | $1,422.18 | $3,819.74 | $6,843.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.54 / $2,448.56 / $4,661.50
| Facility | | $1,640.54 | $2,448.56 | $4,661.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,028.40 / $12,193.83
| Professional | | $1,028.40 | $1,028.40 | $12,193.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,028.40 / $1,469.14
| Professional | | $1,028.40 | $1,028.40 | $1,469.14 |