- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.09 / $4,411.84 / $9,248.34
| Facility | | $1,528.09 | $4,411.84 | $9,248.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.08 / $1,418.22 / $2,296.96
| Professional | | $1,203.08 | $1,418.22 | $2,296.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,264.00 / $12,274.00
| Facility | | $3,877.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.42 / $1,541.03 / $2,389.54
| Professional | | $1,172.42 | $1,541.03 | $2,389.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,001.65 / $4,171.74 / $5,272.36
| Facility | | $4,001.65 | $4,171.74 | $5,272.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.33 / $1,820.15 / $3,066.96
| Professional | | $1,242.33 | $1,820.15 | $3,066.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,059.00 / $6,527.50 / $12,055.49
| Facility | | $3,059.00 | $6,527.50 | $12,055.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.80 / $1,718.08 / $2,879.11
| Professional | | $1,149.80 | $1,718.08 | $2,879.11 |