- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,157.80 / $3,466.93 / $9,248.03
| Facility | | $3,157.80 | $3,466.93 | $9,248.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,016.09 / $4,362.80 / $8,655.69
| Facility | | $3,016.09 | $4,362.80 | $8,655.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.80 / $2,011.02 / $5,182.74
| Professional | | $1,495.80 | $2,011.02 | $5,182.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,184.71 / $4,301.46 / $12,128.60
| Facility | | $2,184.71 | $4,301.46 | $12,128.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.90 / $3,848.76 / $6,798.61
| Professional | | $2,480.90 | $3,848.76 | $6,798.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,529.04 / $3,290.76 / $4,487.39
| Professional | | $1,529.04 | $3,290.76 | $4,487.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.08 / $1,994.40 / $5,833.29
| Professional | | $1,396.08 | $1,994.40 | $5,833.29 |