- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,522.50 / $5,300.18 / $9,399.21
| Facility | | $2,522.50 | $5,300.18 | $9,399.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,302.67 / $5,140.67 / $7,737.50
| Professional | | $4,302.67 | $5,140.67 | $7,737.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.84 / $8,522.55 / $14,754.38
| Facility | | $4,114.84 | $8,522.55 | $14,754.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,076.76 / $5,771.93 / $9,812.68
| Professional | | $4,076.76 | $5,771.93 | $9,812.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $785.00 / $5,597.96
| Facility | | $680.00 | $785.00 | $5,597.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,208.93 / $6,854.01 / $11,437.81
| Professional | | $4,208.93 | $6,854.01 | $11,437.81 |
- 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
- $4,418.60 / $6,134.37 / $11,016.79
| Professional | | $4,418.60 | $6,134.37 | $11,016.79 |