- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.48 / $3,695.07 / $8,074.63
| Facility | | $1,548.48 | $3,695.07 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.02 / $1,665.28 / $2,206.42
| Professional | | $1,379.02 | $1,665.28 | $2,206.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.32 / $2,937.55 / $10,382.04
| Facility | | $1,603.32 | $2,937.55 | $10,382.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.59 / $1,685.02 / $2,675.69
| Professional | | $1,343.59 | $1,685.02 | $2,675.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,904.07 / $3,120.73 / $6,863.18
| Facility | | $1,904.07 | $3,120.73 | $6,863.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.47 / $2,046.36 / $3,196.72
| Professional | | $1,431.47 | $2,046.36 | $3,196.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.15 / $3,530.00 / $8,571.50
| Facility | | $1,379.15 | $3,530.00 | $8,571.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.55 / $1,879.67 / $3,378.30
| Professional | | $1,353.55 | $1,879.67 | $3,378.30 |