- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.84 / $3,772.57 / $8,074.63
| Facility | | $1,561.84 | $3,772.57 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.16 / $1,709.55 / $2,548.75
| Professional | | $1,475.16 | $1,709.55 | $2,548.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,043.88 / $8,915.89 / $14,105.84
| Facility | | $4,043.88 | $8,915.89 | $14,105.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,484.32 / $1,878.66 / $3,105.76
| Professional | | $1,484.32 | $1,878.66 | $3,105.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,714.18 / $1,714.18 / $2,357.69
| Facility | | $1,714.18 | $1,714.18 | $2,357.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.68 / $2,251.69 / $3,541.31
| Professional | | $1,536.68 | $2,251.69 | $3,541.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,487.26 / $2,083.64 / $3,507.86
| Professional | | $1,487.26 | $2,083.64 | $3,507.86 |