- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.80 / $3,772.57 / $8,074.63
| Facility | | $1,604.80 | $3,772.57 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,429.51 / $1,667.73 / $2,630.32
| Professional | | $1,429.51 | $1,667.73 | $2,630.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,048.48
| Facility | | $8,105.25 | $16,184.00 | $28,048.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.67 / $2,025.13 / $3,215.04
| Professional | | $1,500.67 | $2,025.13 | $3,215.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.08 / $1,835.08 / $2,567.48
| Facility | | $1,835.08 | $1,835.08 | $2,567.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.49 / $2,372.73 / $3,845.78
| Professional | | $1,624.49 | $2,372.73 | $3,845.78 |
- 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
- $1,613.27 / $2,212.41 / $3,993.10
| Professional | | $1,613.27 | $2,212.41 | $3,993.10 |