- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,344.23 / $4,897.79
| Facility | | $1,548.82 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,621.81 / $2,454.71
| Professional | | $1,412.54 | $1,621.81 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $17,378.01 / $25,703.96
| Facility | | $8,317.64 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,659.59 / $2,630.27
| Professional | | $1,258.93 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,479.11 / $1,584.89
| Facility | | $1,348.96 | $1,479.11 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,290.87 / $3,235.94
| Facility | | $1,479.11 | $2,290.87 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $3,981.07
| Professional | | $1,412.54 | $1,862.09 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,778.28 / $2,884.03
| Professional | | $1,288.25 | $1,778.28 | $2,884.03 |