- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.91 / $4,744.50 / $9,450.50
| Facility | | $1,525.91 | $4,744.50 | $9,450.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,352.48 / $1,479.58 / $1,695.62
| Professional | | $1,352.48 | $1,479.58 | $1,695.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $9,324.00 / $17,206.00
| Facility | | $4,568.00 | $9,324.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.87 / $1,998.63 / $4,547.55
| Professional | | $1,322.87 | $1,998.63 | $4,547.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,463.97 / $8,463.97 / $8,946.47
| Facility | | $8,463.97 | $8,463.97 | $8,946.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,505.44 / $2,718.77 / $3,635.31
| Professional | | $2,505.44 | $2,718.77 | $3,635.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,616.74 / $2,240.57 / $3,687.31
| Professional | | $1,616.74 | $2,240.57 | $3,687.31 |