- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.89 / $3,772.57 / $7,879.32
| Facility | | $1,763.89 | $3,772.57 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.10 / $1,877.50 / $2,916.20
| Professional | | $1,598.10 | $1,877.50 | $2,916.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.84 / $8,947.00 / $14,433.40
| Facility | | $4,114.84 | $8,947.00 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,629.85 / $2,111.73 / $3,599.46
| Professional | | $1,629.85 | $2,111.73 | $3,599.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,040.31
| Facility | | $680.00 | $870.49 | $2,040.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.04 / $2,458.00 / $4,203.50
| Professional | | $1,669.04 | $2,458.00 | $4,203.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $2,766.50 / $6,819.50
| Facility | | $781.00 | $2,766.50 | $6,819.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.11 / $2,232.76 / $3,968.43
| Professional | | $1,609.11 | $2,232.76 | $3,968.43 |