- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,311.31 / $8,709.64
| Facility | | $1,584.89 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,548.82 / $2,089.30
| Professional | | $1,258.93 | $1,548.82 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,951.21 / $9,120.11
| Facility | | $1,174.90 | $2,951.21 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $549.54 / $2,290.87
| Professional | | $501.19 | $549.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,019.95 / $7,762.47
| Facility | | $1,230.27 | $3,019.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $5,623.41
| Professional | | $2,187.76 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,905.46 / $2,290.87
| Facility | | $794.33 | $1,905.46 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $2,290.87
| Professional | | $794.33 | $1,148.15 | $2,290.87 |