- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,804.54 / $9,804.54 / $9,804.54
| Professional | | $9,804.54 | $9,804.54 | $9,804.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.22 / $277.56 / $437.16
| Professional | | $139.22 | $277.56 | $437.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,805.45 / $8,805.45 / $8,805.45
| Facility | | $8,805.45 | $8,805.45 | $8,805.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,774.00 / $9,804.54 / $14,020.51
| Facility | | $2,774.00 | $9,804.54 | $14,020.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,113.00 / $3,533.00 / $5,307.00
| Facility | | $2,113.00 | $3,533.00 | $5,307.00 |