- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.50 / $2,445.48 / $5,078.37
| Facility | | $1,532.50 | $2,445.48 | $5,078.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.26 / $1,527.84 / $1,676.90
| Professional | | $1,304.26 | $1,527.84 | $1,676.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.80 / $2,734.28 / $7,266.56
| Facility | | $436.80 | $2,734.28 | $7,266.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $208.00 / $1,745.91
| Professional | | $208.00 | $208.00 | $1,745.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,553.22 / $2,522.69 / $5,521.08
| Facility | | $1,553.22 | $2,522.69 | $5,521.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,269.44 / $2,269.44 / $2,719.06
| Professional | | $2,269.44 | $2,269.44 | $2,719.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.22 / $1,863.22 / $2,794.83
| Facility | | $1,863.22 | $1,863.22 | $2,794.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $1,117.93 / $2,329.03
| Professional | | $782.55 | $1,117.93 | $2,329.03 |