- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,524.97 / $3,772.57 / $8,074.63
| Facility | | $1,524.97 | $3,772.57 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.93 / $1,596.16 / $2,478.46
| Professional | | $1,448.93 | $1,596.16 | $2,478.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,577.77 / $19,959.86
| Facility | | $5,195.00 | $10,577.77 | $19,959.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.00 / $1,769.99 / $2,947.07
| Professional | | $1,418.00 | $1,769.99 | $2,947.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,675.87 / $1,675.87 / $2,321.92
| Facility | | $1,675.87 | $1,675.87 | $2,321.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.56 / $2,168.84 / $3,649.59
| Professional | | $1,442.56 | $2,168.84 | $3,649.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $3,236.00 / $6,792.00
| Facility | | $1,367.00 | $3,236.00 | $6,792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,400.81 / $1,988.29 / $3,465.95
| Professional | | $1,400.81 | $1,988.29 | $3,465.95 |