- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.09 / $3,606.50 / $8,074.63
| Facility | | $1,158.09 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.56 / $1,111.61 / $1,775.45
| Professional | | $1,000.56 | $1,111.61 | $1,775.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,269.77 / $19,699.32
| Facility | | $5,195.00 | $10,269.77 | $19,699.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.88 / $1,374.07 / $2,086.72
| Professional | | $1,014.88 | $1,374.07 | $2,086.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.29 / $1,172.29 / $1,615.78
| Facility | | $1,172.29 | $1,172.29 | $1,615.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.35 / $1,541.64 / $2,416.27
| Professional | | $1,053.35 | $1,541.64 | $2,416.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.50 / $3,297.00 / $8,175.00
| Facility | | $1,283.50 | $3,297.00 | $8,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.39 / $1,453.34 / $2,431.94
| Professional | | $1,015.39 | $1,453.34 | $2,431.94 |