- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.81 / $3,606.50 / $8,074.63
| Facility | | $1,310.81 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.31 / $1,409.28 / $2,094.23
| Professional | | $1,211.31 | $1,409.28 | $2,094.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,879.72 / $8,561.50 / $13,618.42
| Facility | | $3,879.72 | $8,561.50 | $13,618.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,219.73 / $1,593.29 / $2,556.94
| Professional | | $1,219.73 | $1,593.29 | $2,556.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,409.58 / $1,409.58 / $1,941.78
| Facility | | $1,409.58 | $1,409.58 | $1,941.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.83 / $1,854.10 / $2,905.01
| Professional | | $1,265.83 | $1,854.10 | $2,905.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.86 / $1,690.46 / $2,904.65
| Professional | | $1,205.86 | $1,690.46 | $2,904.65 |