- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.02 / $3,949.50 / $7,940.20
| Facility | | $2,050.02 | $3,949.50 | $7,940.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,890.44 / $2,223.48 / $3,352.60
| Professional | | $1,890.44 | $2,223.48 | $3,352.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.95 / $8,593.09 / $13,917.11
| Facility | | $3,573.95 | $8,593.09 | $13,917.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.19 / $2,517.05 / $4,256.13
| Professional | | $1,911.19 | $2,517.05 | $4,256.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,420.59
| Facility | | $680.00 | $870.49 | $2,420.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.67 / $2,895.35 / $4,933.92
| Professional | | $1,772.67 | $2,895.35 | $4,933.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.69 / $2,576.92 / $4,620.59
| Professional | | $1,862.69 | $2,576.92 | $4,620.59 |