- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,890.45 / $8,511.38
| Facility | | $1,348.96 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,318.26 / $2,398.83
| Professional | | $1,148.15 | $1,318.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,964.78 / $17,782.79
| Facility | | $6,918.31 | $10,964.78 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $2,041.74
| Professional | | $1,318.26 | $1,659.59 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,981.07 / $10,232.93
| Facility | | $1,230.27 | $3,981.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,548.82 / $9,772.37
| Professional | | $1,202.26 | $1,548.82 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $1,949.84
| Professional | | $1,096.48 | $1,380.38 | $1,949.84 |