- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,123.97 / $5,432.58 / $8,116.49
| Facility | | $3,123.97 | $5,432.58 | $8,116.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,880.00 / $2,832.01 / $3,160.17
| Professional | | $1,880.00 | $2,832.01 | $3,160.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,066.74 / $3,066.74 / $3,748.63
| Professional | | $3,066.74 | $3,066.74 | $3,748.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.88 / $2,495.26 / $5,911.46
| Facility | | $1,450.88 | $2,495.26 | $5,911.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,788.13 / $4,193.50 / $4,260.59
| Professional | | $2,788.13 | $4,193.50 | $4,260.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,880.00 / $1,880.00 / $5,080.10
| Facility | | $1,880.00 | $1,880.00 | $5,080.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $5,955.98
| Professional | | $1,226.23 | $1,751.76 | $5,955.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $4,671.35
| Professional | | $1,226.23 | $1,751.76 | $4,671.35 |