- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,344.23 / $4,897.79
| Facility | | $1,348.96 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,258.93 / $2,290.87
| Professional | | $1,122.02 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $19,054.61 / $26,302.68
| Facility | | $9,549.93 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,621.81 / $2,511.89
| Professional | | $1,047.13 | $1,621.81 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,202.26 / $1,380.38
| Facility | | $1,174.90 | $1,202.26 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,949.84 / $2,511.89
| Facility | | $1,230.27 | $1,949.84 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $2,818.38
| Professional | | $1,071.52 | $1,513.56 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,380.38 / $2,344.23
| Professional | | $1,071.52 | $1,380.38 | $2,344.23 |