- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.75 / $4,055.50 / $8,181.00
| Facility | | $1,320.75 | $4,055.50 | $8,181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.47 / $1,206.43 / $1,944.00
| Professional | | $1,062.47 | $1,206.43 | $1,944.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,247.00 / $8,800.00
| Facility | | $2,740.00 | $4,247.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.33 / $1,451.82 / $2,271.10
| Professional | | $1,146.33 | $1,451.82 | $2,271.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.81 / $1,345.81 / $2,711.88
| Facility | | $1,345.81 | $1,345.81 | $2,711.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.97 / $1,711.17 / $2,812.83
| Professional | | $1,176.97 | $1,711.17 | $2,812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $4,116.68 / $7,934.00
| Facility | | $1,981.00 | $4,116.68 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.96 / $1,603.32 / $2,738.15
| Professional | | $1,129.96 | $1,603.32 | $2,738.15 |