- 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
- $1,053.00 / $2,088.44 / $2,281.50
| Professional | | $1,053.00 | $2,088.44 | $2,281.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,033.61 / $3,941.95 / $5,831.71
| Facility | | $2,033.61 | $3,941.95 | $5,831.71 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $944.94 / $2,281.50
| Professional | | $737.10 | $944.94 | $2,281.50 |