- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,827.63 / $3,772.57 / $7,879.32
| Facility | | $1,827.63 | $3,772.57 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.57 / $1,962.80 / $3,051.01
| Professional | | $1,674.57 | $1,962.80 | $3,051.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,892.92 / $8,593.09 / $13,917.11
| Facility | | $3,892.92 | $8,593.09 | $13,917.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,640.51 / $2,202.32 / $3,767.71
| Professional | | $1,640.51 | $2,202.32 | $3,767.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,130.71
| Facility | | $680.00 | $870.49 | $2,130.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.44 / $2,583.52 / $4,401.62
| Professional | | $1,638.44 | $2,583.52 | $4,401.62 |
- 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
- $1,667.60 / $2,280.09 / $4,309.62
| Professional | | $1,667.60 | $2,280.09 | $4,309.62 |