- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.71 / $4,243.50 / $8,572.13
| Facility | | $1,579.71 | $4,243.50 | $8,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.53 / $1,446.78 / $2,353.65
| Professional | | $1,282.53 | $1,446.78 | $2,353.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,068.50 / $10,449.50 / $21,886.55
| Facility | | $5,068.50 | $10,449.50 | $21,886.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.23 / $1,806.44 / $2,771.48
| Professional | | $1,334.23 | $1,806.44 | $2,771.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,576.24
| Facility | | $895.00 | $950.00 | $1,576.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.04 / $2,078.91 / $3,140.97
| Professional | | $1,406.04 | $2,078.91 | $3,140.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.09 / $1,824.50 / $3,076.90
| Professional | | $1,309.09 | $1,824.50 | $3,076.90 |