- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,683.00 / $8,400.00
| Facility | | $1,150.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.32 / $1,320.65 / $1,320.65
| Professional | | $1,141.32 | $1,320.65 | $1,320.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,334.45 / $14,829.12 / $23,429.85
| Facility | | $9,334.45 | $14,829.12 | $23,429.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,703.09 / $4,703.09 / $4,703.09
| Facility | | $4,703.09 | $4,703.09 | $4,703.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.80 / $1,695.90 / $2,126.71
| Professional | | $1,224.80 | $1,695.90 | $2,126.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.65 / $1,888.53 / $8,986.49
| Facility | | $1,320.65 | $1,888.53 | $8,986.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.34 / $1,445.32 / $9,976.00
| Professional | | $1,127.34 | $1,445.32 | $9,976.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $9,232.95
| Facility | | $1,481.00 | $5,910.00 | $9,232.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.03 / $1,392.60 / $1,886.86
| Professional | | $1,061.03 | $1,392.60 | $1,886.86 |