- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.68 / $4,055.50 / $8,181.00
| Facility | | $1,391.68 | $4,055.50 | $8,181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.14 / $1,336.61 / $2,140.36
| Professional | | $1,132.14 | $1,336.61 | $2,140.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,196.00 / $10,517.23
| Facility | | $3,302.10 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.84 / $1,407.94 / $2,318.33
| Professional | | $1,008.84 | $1,407.94 | $2,318.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.12 / $1,359.30 / $1,917.07
| Facility | | $920.12 | $1,359.30 | $1,917.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.36 / $1,448.89 / $2,390.42
| Professional | | $1,007.36 | $1,448.89 | $2,390.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.50 / $9,332.00
| Facility | | $2,155.00 | $4,983.50 | $9,332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.27 / $1,292.85 / $2,355.21
| Professional | | $971.27 | $1,292.85 | $2,355.21 |