- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.05 / $3,889.50 / $8,373.50
| Facility | | $1,831.05 | $3,889.50 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.91 / $2,228.38 / $2,518.29
| Professional | | $1,869.91 | $2,228.38 | $2,518.29 |
- 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
- $2,106.32 / $2,578.39 / $3,787.36
| Professional | | $2,106.32 | $2,578.39 | $3,787.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.11 / $2,327.11 / $5,248.13
| Facility | | $2,327.11 | $2,327.11 | $5,248.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.91 / $2,841.55 / $4,775.39
| Professional | | $1,975.91 | $2,841.55 | $4,775.39 |
- 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
- $1,617.08 / $2,433.96 / $4,390.05
| Professional | | $1,617.08 | $2,433.96 | $4,390.05 |