- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,019.95 / $8,128.31
| Facility | | $1,445.44 | $3,019.95 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $1,995.26
| Professional | | $1,148.15 | $1,412.54 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,951.21 / $8,511.38
| Facility | | $1,288.25 | $2,951.21 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $501.19 / $2,041.74
| Professional | | $426.58 | $501.19 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,818.38 / $7,079.46
| Facility | | $1,148.15 | $2,818.38 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,570.40 / $4,786.30
| Professional | | $2,041.74 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $2,089.30
| Facility | | $1,047.13 | $1,737.80 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $2,089.30
| Professional | | $741.31 | $1,047.13 | $2,089.30 |