- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,887.54 / $3,889.50 / $8,373.50
| Facility | | $1,887.54 | $3,889.50 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,987.89 / $2,411.01 / $2,712.01
| Professional | | $1,987.89 | $2,411.01 | $2,712.01 |
- 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
- $2,553.17 / $3,134.30 / $4,171.13
| Professional | | $2,553.17 | $3,134.30 | $4,171.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,478.71 / $2,478.71 / $5,354.61
| Facility | | $2,478.71 | $2,478.71 | $5,354.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,117.14 / $3,034.83 / $5,061.79
| Professional | | $2,117.14 | $3,034.83 | $5,061.79 |
- 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
- $1,800.17 / $2,627.69 / $4,779.81
| Professional | | $1,800.17 | $2,627.69 | $4,779.81 |