- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.57 / $3,736.81 / $8,074.63
| Facility | | $1,636.57 | $3,736.81 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.56 / $1,766.92 / $2,342.58
| Professional | | $1,442.56 | $1,766.92 | $2,342.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,766.98 / $14,405.53
| Facility | | $4,636.21 | $8,766.98 | $14,405.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.80 / $1,808.94 / $2,851.90
| Professional | | $1,378.80 | $1,808.94 | $2,851.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.54 / $1,681.54 / $4,573.49
| Facility | | $1,681.54 | $1,681.54 | $4,573.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.03 / $2,125.73 / $3,403.69
| Professional | | $1,495.03 | $2,125.73 | $3,403.69 |
- 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
- $1,422.57 / $2,037.90 / $3,593.68
| Professional | | $1,422.57 | $2,037.90 | $3,593.68 |