- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,698.24 / $2,454.71
| Facility | | $1,412.54 | $1,698.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,288.25 / $1,621.81
| Professional | | $1,148.15 | $1,288.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $8,511.38
| Facility | | $6,309.57 | $6,309.57 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,398.83
| Professional | | $1,819.70 | $1,819.70 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $2,187.76 / $2,754.23
| Professional | | $912.01 | $2,187.76 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,981.07 / $12,589.25
| Facility | | $1,548.82 | $3,981.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,318.26 / $2,454.71
| Professional | | $1,047.13 | $1,318.26 | $2,454.71 |