- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.48 / $3,650.50 / $8,074.63
| Facility | | $1,128.48 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.39 / $1,155.84 / $1,599.26
| Professional | | $1,026.39 | $1,155.84 | $1,599.26 |
- 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
- $984.39 / $1,328.88 / $2,002.00
| Professional | | $984.39 | $1,328.88 | $2,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.42 / $1,116.42 / $2,959.94
| Facility | | $1,116.42 | $1,116.42 | $2,959.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.66 / $1,478.00 / $2,486.91
| Professional | | $1,082.66 | $1,478.00 | $2,486.91 |
- 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
- $1,016.86 / $1,493.83 / $2,484.23
| Professional | | $1,016.86 | $1,493.83 | $2,484.23 |