- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.99 / $3,606.50 / $8,074.63
| Facility | | $1,258.99 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.41 / $1,259.68 / $1,925.27
| Professional | | $1,046.41 | $1,259.68 | $1,925.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,037.44 / $16,184.00 / $28,850.83
| Facility | | $8,037.44 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.21 / $1,556.40 / $2,518.44
| Professional | | $1,175.21 | $1,556.40 | $2,518.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,434.85 / $1,434.85 / $2,010.66
| Facility | | $1,434.85 | $1,434.85 | $2,010.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.17 / $1,803.09 / $2,857.00
| Professional | | $1,256.17 | $1,803.09 | $2,857.00 |
- 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
- $1,173.92 / $1,605.91 / $2,837.93
| Professional | | $1,173.92 | $1,605.91 | $2,837.93 |