- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.34 / $3,695.07 / $8,074.63
| Facility | | $1,442.34 | $3,695.07 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.02 / $1,548.04 / $2,146.14
| Professional | | $1,310.02 | $1,548.04 | $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
- $1,265.19 / $1,687.47 / $2,623.50
| Professional | | $1,265.19 | $1,687.47 | $2,623.50 |
- 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
- $1,379.00 / $1,971.59 / $3,312.01
| Professional | | $1,379.00 | $1,971.59 | $3,312.01 |
- 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
- $1,321.00 / $1,884.48 / $3,204.87
| Professional | | $1,321.00 | $1,884.48 | $3,204.87 |