- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,897.79 / $7,244.36
| Facility | | $1,230.27 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $2,187.76
| Professional | | $1,023.29 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $18,197.01 / $26,302.68
| Facility | | $2,818.38 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $2,238.72
| Professional | | $1,071.52 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,174.90 / $1,318.26
| Facility | | $1,047.13 | $1,174.90 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,479.11
| Facility | | $1,230.27 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,479.11 / $2,398.83
| Professional | | $1,096.48 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $7,762.47 / $10,964.78
| Facility | | $1,621.81 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $2,187.76
| Professional | | $954.99 | $1,288.25 | $2,187.76 |