- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,002.09 / $4,683.26 / $9,006.27
| Facility | | $3,002.09 | $4,683.26 | $9,006.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,440.82 / $2,500.00
| Professional | | $1,500.00 | $2,440.82 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.50 / $4,405.57 / $11,708.15
| Facility | | $1,557.50 | $4,405.57 | $11,708.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.83 / $1,440.00 / $3,002.09
| Professional | | $1,200.83 | $1,440.00 | $3,002.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,653.85 / $5,024.75 / $8,781.12
| Facility | | $2,653.85 | $5,024.75 | $8,781.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,484.29 / $3,656.78 / $4,381.22
| Professional | | $3,484.29 | $3,656.78 | $4,381.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,701.88 / $2,701.88 / $2,701.88
| Facility | | $2,701.88 | $2,701.88 | $2,701.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,801.25 / $3,452.40
| Professional | | $1,260.88 | $1,801.25 | $3,452.40 |