- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.81 / $3,650.50 / $8,074.63
| Facility | | $1,468.81 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.83 / $1,538.23 / $2,123.67
| Professional | | $1,276.83 | $1,538.23 | $2,123.67 |
- 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
- $1,269.04 / $1,728.83 / $2,504.16
| Professional | | $1,269.04 | $1,728.83 | $2,504.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.70 / $1,485.70 / $3,912.62
| Facility | | $1,485.70 | $1,485.70 | $3,912.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.76 / $1,962.50 / $3,232.73
| Professional | | $1,378.76 | $1,962.50 | $3,232.73 |
- 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
- $1,346.00 / $1,948.01 / $3,218.54
| Professional | | $1,346.00 | $1,948.01 | $3,218.54 |