- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,580.38 / $3,695.07 / $8,074.63
| Facility | | $1,580.38 | $3,695.07 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.00 / $1,694.55 / $2,325.04
| Professional | | $1,385.00 | $1,694.55 | $2,325.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.64 / $1,839.40 / $2,755.18
| Professional | | $1,393.64 | $1,839.40 | $2,755.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,599.10 / $1,599.10 / $4,331.04
| Facility | | $1,599.10 | $1,599.10 | $4,331.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.48 / $2,090.89 / $3,423.17
| Professional | | $1,511.48 | $2,090.89 | $3,423.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,152.00
| Facility | | $1,292.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.47 / $2,001.17 / $3,465.66
| Professional | | $1,387.47 | $2,001.17 | $3,465.66 |