- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.59 / $3,772.57 / $8,373.50
| Facility | | $1,616.59 | $3,772.57 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.75 / $1,643.09 / $1,972.15
| Professional | | $974.75 | $1,643.09 | $1,972.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.45 / $1,693.65 / $2,475.00
| Professional | | $1,510.45 | $1,693.65 | $2,475.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.52 / $1,698.52 / $4,806.72
| Facility | | $1,698.52 | $1,698.52 | $4,806.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.94 / $2,245.47 / $3,687.03
| Professional | | $1,515.94 | $2,245.47 | $3,687.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.84 / $2,139.52 / $3,818.42
| Professional | | $1,459.84 | $2,139.52 | $3,818.42 |