- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $1,821.00 / $3,109.00
| Facility | | $1,233.00 | $1,821.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.50 / $1,672.80 / $2,002.56
| Professional | | $1,282.50 | $1,672.80 | $2,002.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.30 / $6,727.30 / $8,072.76
| Facility | | $6,727.30 | $6,727.30 | $8,072.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.16 / $1,886.45 / $1,997.42
| Professional | | $1,509.16 | $1,886.45 | $1,997.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,967.35 / $4,967.35 / $4,967.35
| Facility | | $4,967.35 | $4,967.35 | $4,967.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.94 / $2,166.41 / $2,896.06
| Professional | | $1,456.94 | $2,166.41 | $2,896.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,990.00 / $14,407.00
| Facility | | $2,104.00 | $4,990.00 | $14,407.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,244.70 / $1,742.58 / $2,749.17
| Professional | | $1,244.70 | $1,742.58 | $2,749.17 |