- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.08 / $3,695.07 / $8,074.63
| Facility | | $1,581.08 | $3,695.07 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,392.34 / $1,642.11 / $2,278.75
| Professional | | $1,392.34 | $1,642.11 | $2,278.75 |
- 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
- $1,366.89 / $1,788.51 / $2,684.41
| Professional | | $1,366.89 | $1,788.51 | $2,684.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.21 / $1,595.21 / $4,192.59
| Facility | | $1,595.21 | $1,595.21 | $4,192.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,474.63 / $2,102.04 / $3,367.54
| Professional | | $1,474.63 | $2,102.04 | $3,367.54 |
- 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
- $1,398.84 / $2,055.96 / $3,461.41
| Professional | | $1,398.84 | $2,055.96 | $3,461.41 |