- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.15 / $3,321.47 / $7,838.38
| Facility | | $1,303.15 | $3,321.47 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.71 / $1,307.83 / $2,070.50
| Professional | | $1,097.71 | $1,307.83 | $2,070.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,486.55 / $7,367.56 / $12,270.31
| Facility | | $3,486.55 | $7,367.56 | $12,270.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.62 / $1,494.50 / $2,559.32
| Professional | | $1,141.62 | $1,494.50 | $2,559.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,443.76
| Facility | | $680.00 | $870.49 | $1,443.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.47 / $1,711.17 / $2,917.46
| Professional | | $1,151.47 | $1,711.17 | $2,917.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.57 / $1,549.30 / $2,770.63
| Professional | | $1,123.57 | $1,549.30 | $2,770.63 |