- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.59 / $3,664.10 / $7,879.32
| Facility | | $1,650.59 | $3,664.10 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.13 / $1,750.31 / $2,836.53
| Professional | | $1,534.13 | $1,750.31 | $2,836.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $16,401.00 / $29,216.95
| Facility | | $8,512.20 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,701.00 / $2,250.58 / $3,654.70
| Professional | | $1,701.00 | $2,250.58 | $3,654.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,980.56 / $2,105.50 / $4,890.73
| Facility | | $1,980.56 | $2,105.50 | $4,890.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,733.28 / $2,431.89 / $3,834.05
| Professional | | $1,733.28 | $2,431.89 | $3,834.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.50 / $2,958.50 / $6,443.50
| Facility | | $1,278.50 | $2,958.50 | $6,443.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,527.37 / $2,239.14 / $3,908.27
| Professional | | $1,527.37 | $2,239.14 | $3,908.27 |