- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.30 / $2,532.46 / $9,230.95
| Facility | | $1,860.30 | $2,532.46 | $9,230.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,088.44 / $2,281.50
| Professional | | $1,170.00 | $2,088.44 | $2,281.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,049.84 / $3,555.10 / $5,909.47
| Facility | | $2,049.84 | $3,555.10 | $5,909.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $1,950.00
| Facility | | $1,950.00 | $1,950.00 | $1,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.31 / $3,367.03 / $12,395.25
| Facility | | $1,836.31 | $3,367.03 | $12,395.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.79 / $1,170.00 / $1,950.00
| Facility | | $631.79 | $1,170.00 | $1,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $975.00 / $2,535.00
| Professional | | $737.10 | $975.00 | $2,535.00 |