- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.22 / $3,695.07 / $8,074.63
| Facility | | $1,407.22 | $3,695.07 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.14 / $1,587.67 / $2,408.53
| Professional | | $1,300.14 | $1,587.67 | $2,408.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,913.08 / $8,269.50 / $13,211.02
| Facility | | $3,913.08 | $8,269.50 | $13,211.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.58 / $1,676.56 / $2,765.67
| Professional | | $1,342.58 | $1,676.56 | $2,765.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,624.09 / $1,624.09 / $2,117.92
| Facility | | $1,624.09 | $1,624.09 | $2,117.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.40 / $2,091.73 / $3,313.18
| Professional | | $1,447.40 | $2,091.73 | $3,313.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.32 / $1,874.37 / $3,243.89
| Professional | | $1,354.32 | $1,874.37 | $3,243.89 |