- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,401.71 / $3,650.50 / $8,074.63
| Facility | | $1,401.71 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.36 / $1,497.62 / $2,334.46
| Professional | | $1,304.36 | $1,497.62 | $2,334.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.37 / $1,786.19 / $2,994.86
| Professional | | $1,361.37 | $1,786.19 | $2,994.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.62 / $1,704.62 / $2,389.76
| Facility | | $1,704.62 | $1,704.62 | $2,389.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.67 / $2,024.56 / $3,230.14
| Professional | | $1,337.67 | $2,024.56 | $3,230.14 |
- 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
- $1,311.71 / $1,851.83 / $3,477.76
| Professional | | $1,311.71 | $1,851.83 | $3,477.76 |