- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,466.84 / $12,022.64
| Facility | | $2,187.76 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,137.96 / $4,168.69
| Professional | | $1,698.24 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $11,481.54
| Facility | | $2,454.71 | $3,235.94 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $5,248.07
| Professional | | $1,230.27 | $1,445.44 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,786.30 / $10,715.19
| Facility | | $1,621.81 | $4,786.30 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,090.30 / $6,165.95
| Professional | | $1,318.26 | $3,090.30 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,511.89 / $3,090.30
| Facility | | $1,513.56 | $2,511.89 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $3,388.44
| Professional | | $1,047.13 | $1,513.56 | $3,388.44 |