- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.61 / $3,359.50 / $7,879.32
| Facility | | $1,254.61 | $3,359.50 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.33 / $1,238.15 / $1,795.62
| Professional | | $1,061.33 | $1,238.15 | $1,795.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.84 / $8,805.92 / $14,433.40
| Facility | | $4,114.84 | $8,805.92 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.08 / $1,390.93 / $2,383.51
| Professional | | $1,066.08 | $1,390.93 | $2,383.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,343.08
| Facility | | $680.00 | $870.49 | $1,343.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.07 / $1,605.36 / $2,733.76
| Professional | | $1,078.07 | $1,605.36 | $2,733.76 |
- 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
- $1,045.68 / $1,475.46 / $2,571.62
| Professional | | $1,045.68 | $1,475.46 | $2,571.62 |