- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.20 / $2,906.38 / $4,234.63
| Facility | | $1,921.20 | $2,906.38 | $4,234.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.42 / $2,737.32 / $3,558.52
| Professional | | $1,277.42 | $2,737.32 | $3,558.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.40 / $3,795.74 / $7,117.02
| Facility | | $1,423.40 | $3,795.74 | $7,117.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.91 / $1,360.38 / $3,355.59
| Professional | | $1,055.91 | $1,360.38 | $3,355.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,195.69 / $3,558.52 / $3,914.37
| Facility | | $2,195.69 | $3,558.52 | $3,914.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.88 / $1,824.88 / $2,189.86
| Professional | | $1,824.88 | $1,824.88 | $2,189.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.03 / $1,642.39 / $3,558.52
| Professional | | $1,396.03 | $1,642.39 | $3,558.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,737.32 / $4,105.97 / $6,715.56
| Facility | | $2,737.32 | $4,105.97 | $6,715.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,134.07 / $3,209.71 / $3,582.71
| Professional | | $3,134.07 | $3,209.71 | $3,582.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.45 / $1,044.06 / $2,858.74
| Professional | | $766.45 | $1,044.06 | $2,858.74 |