- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,622.08 / $5,063.00 / $7,631.00
| Facility | | $1,622.08 | $5,063.00 | $7,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.19 / $1,600.15 / $1,757.54
| Professional | | $1,234.19 | $1,600.15 | $1,757.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,360.54 / $7,050.74 / $13,165.98
| Facility | | $2,360.54 | $7,050.74 | $13,165.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.55 / $2,061.15 / $3,048.39
| Professional | | $1,523.55 | $2,061.15 | $3,048.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.86 / $2,571.21 / $3,757.93
| Professional | | $1,977.86 | $2,571.21 | $3,757.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.00 / $3,629.00 / $10,000.00
| Facility | | $1,036.00 | $3,629.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.61 / $2,142.69 / $3,950.31
| Professional | | $1,421.61 | $2,142.69 | $3,950.31 |