- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.58 / $3,650.50 / $8,074.63
| Facility | | $1,473.58 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.34 / $1,551.67 / $2,146.14
| Professional | | $1,313.34 | $1,551.67 | $2,146.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,883.46 / $15,216.00
| Facility | | $4,769.10 | $8,883.46 | $15,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,294.08 / $1,687.47 / $2,530.87
| Professional | | $1,294.08 | $1,687.47 | $2,530.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,502.02 / $1,502.02 / $3,959.00
| Facility | | $1,502.02 | $1,502.02 | $3,959.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.76 / $1,979.79 / $3,250.52
| Professional | | $1,388.76 | $1,979.79 | $3,250.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.00 / $1,903.50 / $3,253.01
| Professional | | $1,321.00 | $1,903.50 | $3,253.01 |