- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.78 / $3,650.50 / $8,340.00
| Facility | | $1,387.78 | $3,650.50 | $8,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.39 / $1,455.03 / $2,017.26
| Professional | | $1,212.39 | $1,455.03 | $2,017.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,981.00 / $15,216.00
| Facility | | $4,769.10 | $8,981.00 | $15,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.52 / $1,642.64 / $2,420.11
| Professional | | $1,217.52 | $1,642.64 | $2,420.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,410.61 / $1,410.61 / $3,718.35
| Facility | | $1,410.61 | $1,410.61 | $3,718.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,367.45 / $1,858.12 / $3,051.74
| Professional | | $1,367.45 | $1,858.12 | $3,051.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.71 / $1,788.13 / $3,054.17
| Professional | | $1,248.71 | $1,788.13 | $3,054.17 |