- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,816.00 / $7,060.02 / $8,405.21
| Facility | | $5,816.00 | $7,060.02 | $8,405.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.84 / $411.09 / $965.91
| Professional | | $398.84 | $411.09 | $965.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.88 / $1,848.88 / $2,656.00
| Facility | | $1,848.88 | $1,848.88 | $2,656.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.01 / $441.02 / $681.74
| Professional | | $356.01 | $441.02 | $681.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,850.23 / $2,850.23 / $8,550.70
| Facility | | $2,850.23 | $2,850.23 | $8,550.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.00 / $2,200.00 / $2,200.00
| Facility | | $1,248.00 | $2,200.00 | $2,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.56 / $423.86 / $940.62
| Professional | | $335.56 | $423.86 | $940.62 |