- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.73 / $3,606.50 / $8,074.63
| Facility | | $1,184.73 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.84 / $1,243.43 / $1,884.74
| Professional | | $1,067.84 | $1,243.43 | $1,884.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,989.73 / $8,668.10 / $13,628.92
| Facility | | $3,989.73 | $8,668.10 | $13,628.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.80 / $1,322.15 / $2,236.80
| Professional | | $1,070.80 | $1,322.15 | $2,236.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.49 / $1,243.49 / $1,715.16
| Facility | | $1,243.49 | $1,243.49 | $1,715.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.81 / $1,636.18 / $2,568.12
| Professional | | $1,098.81 | $1,636.18 | $2,568.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.43 / $1,524.97 / $2,608.56
| Professional | | $1,065.43 | $1,524.97 | $2,608.56 |