- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.13 / $3,650.50 / $8,074.63
| Facility | | $1,284.13 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.69 / $1,329.80 / $1,844.65
| Professional | | $1,118.69 | $1,329.80 | $1,844.65 |
- 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
- $1,111.90 / $1,500.69 / $2,398.53
| Professional | | $1,111.90 | $1,500.69 | $2,398.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.21 / $1,291.21 / $3,395.73
| Facility | | $1,291.21 | $1,291.21 | $3,395.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.20 / $1,724.04 / $2,858.11
| Professional | | $1,245.20 | $1,724.04 | $2,858.11 |
- 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
- $1,169.60 / $1,707.53 / $2,798.08
| Professional | | $1,169.60 | $1,707.53 | $2,798.08 |