- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.19 / $3,589.91 / $8,074.63
| Facility | | $1,108.19 | $3,589.91 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.82 / $1,072.65 / $1,707.81
| Professional | | $954.82 | $1,072.65 | $1,707.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,299.00 / $11,015.00 / $20,189.45
| Facility | | $5,299.00 | $11,015.00 | $20,189.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.30 / $1,295.58 / $2,066.35
| Professional | | $1,030.30 | $1,295.58 | $2,066.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.48 / $1,224.48 / $1,706.22
| Facility | | $1,224.48 | $1,224.48 | $1,706.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.22 / $1,538.43 / $2,456.77
| Professional | | $1,051.22 | $1,538.43 | $2,456.77 |
- 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
- $1,005.26 / $1,422.10 / $2,402.79
| Professional | | $1,005.26 | $1,422.10 | $2,402.79 |