- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.09 / $3,772.57 / $8,074.63
| Facility | | $1,656.09 | $3,772.57 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.84 / $1,733.05 / $2,324.16
| Professional | | $1,428.84 | $1,733.05 | $2,324.16 |
- 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
- $1,472.06 / $1,935.78 / $2,998.85
| Professional | | $1,472.06 | $1,935.78 | $2,998.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,666.36 / $1,666.36 / $4,383.58
| Facility | | $1,666.36 | $1,666.36 | $4,383.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,633.72 / $2,189.03 / $3,611.26
| Professional | | $1,633.72 | $2,189.03 | $3,611.26 |
- 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
- $1,520.43 / $2,175.28 / $3,609.86
| Professional | | $1,520.43 | $2,175.28 | $3,609.86 |