- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.59 / $3,695.07 / $7,879.32
| Facility | | $1,594.59 | $3,695.07 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.11 / $1,676.80 / $2,392.46
| Professional | | $1,433.11 | $1,676.80 | $2,392.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,486.55 / $7,147.20 / $12,270.31
| Facility | | $3,486.55 | $7,147.20 | $12,270.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.30 / $1,947.80 / $3,222.75
| Professional | | $1,477.30 | $1,947.80 | $3,222.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,821.35
| Facility | | $680.00 | $870.49 | $1,821.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.26 / $2,211.10 / $3,719.16
| Professional | | $1,521.26 | $2,211.10 | $3,719.16 |
- 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
- $1,449.20 / $1,997.66 / $3,635.22
| Professional | | $1,449.20 | $1,997.66 | $3,635.22 |