- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,384.69 / $2,678.03 / $6,983.91
| Facility | | $2,384.69 | $2,678.03 | $6,983.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.48 / $2,037.61 / $5,469.77
| Professional | | $1,642.48 | $2,037.61 | $5,469.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.27 / $3,340.91 / $6,551.65
| Facility | | $2,324.27 | $3,340.91 | $6,551.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.20 / $2,635.72 / $5,377.72
| Professional | | $1,280.20 | $2,635.72 | $5,377.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,512.73 / $3,781.21 / $11,390.10
| Facility | | $2,512.73 | $3,781.21 | $11,390.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.41 / $3,116.10 / $6,242.58
| Professional | | $1,679.41 | $3,116.10 | $6,242.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.15 / $3,343.60 / $4,769.39
| Professional | | $1,757.15 | $3,343.60 | $4,769.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.70 / $1,608.54 / $4,405.17
| Professional | | $1,154.70 | $1,608.54 | $4,405.17 |