- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.00 / $2,477.00 / $4,109.49
| Facility | | $1,342.00 | $2,477.00 | $4,109.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,953.11 / $2,581.01 / $3,083.67
| Professional | | $1,953.11 | $2,581.01 | $3,083.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.65 / $2,958.31 / $3,132.33
| Professional | | $2,366.65 | $2,958.31 | $3,132.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,155.17 / $3,290.12 / $4,142.97
| Professional | | $2,155.17 | $3,290.12 | $4,142.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,741.00 / $7,019.00 / $12,000.00
| Facility | | $3,741.00 | $7,019.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.54 / $2,415.60 / $4,183.41
| Professional | | $1,983.54 | $2,415.60 | $4,183.41 |