- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.71 / $3,650.50 / $8,074.63
| Facility | | $1,334.71 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.35 / $1,396.85 / $1,999.47
| Professional | | $1,160.35 | $1,396.85 | $1,999.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,766.98 / $14,405.53
| Facility | | $4,636.21 | $8,766.98 | $14,405.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.51 / $1,550.00 / $2,318.13
| Professional | | $1,166.51 | $1,550.00 | $2,318.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.21 / $1,322.21 / $3,479.01
| Facility | | $1,322.21 | $1,322.21 | $3,479.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.84 / $1,801.39 / $2,886.31
| Professional | | $1,320.84 | $1,801.39 | $2,886.31 |
- 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
- $1,213.01 / $1,745.02 / $3,000.81
| Professional | | $1,213.01 | $1,745.02 | $3,000.81 |