- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,677.42 / $3,772.57 / $8,074.63
| Facility | | $1,677.42 | $3,772.57 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.40 / $1,704.24 / $2,377.07
| Professional | | $1,461.40 | $1,704.24 | $2,377.07 |
- 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
- $1,463.68 / $1,979.56 / $3,165.59
| Professional | | $1,463.68 | $1,979.56 | $3,165.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.40 / $1,704.40 / $4,480.42
| Facility | | $1,704.40 | $1,704.40 | $4,480.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.28 / $2,255.39 / $3,720.59
| Professional | | $1,651.28 | $2,255.39 | $3,720.59 |
- 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
- $1,543.12 / $2,183.86 / $3,800.61
| Professional | | $1,543.12 | $2,183.86 | $3,800.61 |