- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,220.76 / $1,220.76 / $8,270.50
| Facility | | $1,220.76 | $1,220.76 | $8,270.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.92 / $1,017.73 / $1,087.91
| Professional | | $777.92 | $1,017.73 | $1,087.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,263.19 / $7,263.19 / $7,263.19
| Facility | | $7,263.19 | $7,263.19 | $7,263.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.95 / $1,813.71 / $2,406.65
| Professional | | $1,743.95 | $1,813.71 | $2,406.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,169.46 / $4,296.22 / $9,943.68
| Facility | | $3,169.46 | $4,296.22 | $9,943.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.80 / $1,266.23 / $2,092.73
| Facility | | $1,169.80 | $1,266.23 | $2,092.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,500.00 / $1,500.00
| Professional | | $1,500.00 | $1,500.00 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.32 / $701.88 / $1,169.80
| Professional | | $491.32 | $701.88 | $1,169.80 |