- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.03 / $3,650.50 / $8,074.63
| Facility | | $1,427.03 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.83 / $1,514.35 / $2,091.19
| Professional | | $1,246.83 | $1,514.35 | $2,091.19 |
- 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
- $1,254.81 / $1,641.27 / $2,658.52
| Professional | | $1,254.81 | $1,641.27 | $2,658.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,446.43 / $1,446.43 / $3,902.26
| Facility | | $1,446.43 | $1,446.43 | $3,902.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.69 / $1,914.01 / $3,125.00
| Professional | | $1,406.69 | $1,914.01 | $3,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $3,236.00 / $7,168.00
| Facility | | $1,367.00 | $3,236.00 | $7,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.67 / $1,832.34 / $3,191.10
| Professional | | $1,272.67 | $1,832.34 | $3,191.10 |