- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.21 / $3,359.50 / $7,879.32
| Facility | | $1,229.21 | $3,359.50 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.91 / $1,206.55 / $1,747.14
| Professional | | $1,037.91 | $1,206.55 | $1,747.14 |
- 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
- $1,049.71 / $1,358.21 / $2,327.66
| Professional | | $1,049.71 | $1,358.21 | $2,327.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,306.61
| Facility | | $680.00 | $870.49 | $1,306.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.78 / $1,554.93 / $2,659.33
| Professional | | $1,049.78 | $1,554.93 | $2,659.33 |
- 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
- $1,030.10 / $1,407.42 / $2,521.13
| Professional | | $1,030.10 | $1,407.42 | $2,521.13 |