- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $3,803.00 / $12,600.00
| Facility | | $1,200.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.84 / $1,408.79 / $1,429.79
| Professional | | $1,120.84 | $1,408.79 | $1,429.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,581.43 / $7,581.43 / $7,581.43
| Facility | | $7,581.43 | $7,581.43 | $7,581.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.91 / $1,549.26 / $2,079.16
| Professional | | $926.91 | $1,549.26 | $2,079.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.76 / $1,854.51 / $8,753.15
| Facility | | $1,235.76 | $1,854.51 | $8,753.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.60 / $1,394.31 / $9,868.71
| Professional | | $837.60 | $1,394.31 | $9,868.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $11,050.00
| Facility | | $1,481.00 | $5,910.00 | $11,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.70 / $1,264.15 / $1,986.19
| Professional | | $802.70 | $1,264.15 | $1,986.19 |