- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.70 / $3,606.50 / $8,074.63
| Facility | | $1,242.70 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.38 / $1,206.41 / $1,855.93
| Professional | | $1,066.38 | $1,206.41 | $1,855.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,032.66 / $8,683.04 / $13,628.92
| Facility | | $4,032.66 | $8,683.04 | $13,628.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.33 / $1,461.40 / $2,224.29
| Professional | | $1,082.33 | $1,461.40 | $2,224.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.77 / $1,250.77 / $1,723.05
| Facility | | $1,250.77 | $1,250.77 | $1,723.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.34 / $1,643.19 / $2,639.74
| Professional | | $1,118.34 | $1,643.19 | $2,639.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.43 / $1,529.96 / $2,515.19
| Professional | | $1,103.43 | $1,529.96 | $2,515.19 |