- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.61 / $3,695.07 / $8,074.63
| Facility | | $1,443.61 | $3,695.07 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.12 / $1,472.50 / $2,282.52
| Professional | | $1,334.12 | $1,472.50 | $2,282.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,236.97
| Facility | | $8,105.25 | $16,184.00 | $28,236.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.00 / $1,919.51 / $2,864.21
| Professional | | $1,422.00 | $1,919.51 | $2,864.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.76 / $1,635.76 / $2,278.82
| Facility | | $1,635.76 | $1,635.76 | $2,278.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.06 / $2,126.10 / $3,390.43
| Professional | | $1,517.06 | $2,126.10 | $3,390.43 |
- 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
- $1,421.83 / $2,010.40 / $3,530.78
| Professional | | $1,421.83 | $2,010.40 | $3,530.78 |