- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.09 / $4,624.50 / $9,050.50
| Facility | | $1,653.09 | $4,624.50 | $9,050.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.39 / $1,491.37 / $2,312.96
| Professional | | $1,242.39 | $1,491.37 | $2,312.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,264.00 / $12,538.00
| Facility | | $3,877.00 | $7,264.00 | $12,538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.56 / $1,518.77 / $2,513.02
| Professional | | $1,186.56 | $1,518.77 | $2,513.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,383.06 / $4,362.33 / $8,874.01
| Facility | | $3,383.06 | $4,362.33 | $8,874.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.10 / $2,221.90 / $2,793.87
| Professional | | $1,628.10 | $2,221.90 | $2,793.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.50 / $5,936.50 / $11,317.00
| Facility | | $3,007.50 | $5,936.50 | $11,317.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.19 / $1,495.45 / $2,663.37
| Professional | | $1,164.19 | $1,495.45 | $2,663.37 |