- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.57 / $3,332.33 / $7,205.02
| Facility | | $2,251.57 | $3,332.33 | $7,205.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.84 / $2,500.00 / $2,500.00
| Professional | | $2,398.84 | $2,500.00 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.11 / $295.77 / $428.45
| Facility | | $218.11 | $295.77 | $428.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,851.99 / $2,851.99 / $2,851.99
| Professional | | $2,851.99 | $2,851.99 | $2,851.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.36 / $1,951.36 / $8,020.09
| Facility | | $1,951.36 | $1,951.36 | $8,020.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,656.78 / $3,656.78 / $4,381.22
| Professional | | $3,656.78 | $3,656.78 | $4,381.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.55 / $2,927.04 / $5,043.51
| Facility | | $2,221.55 | $2,927.04 | $5,043.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,260.88 / $4,503.14
| Professional | | $1,260.88 | $1,260.88 | $4,503.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,260.88 / $1,921.34
| Professional | | $1,260.88 | $1,260.88 | $1,921.34 |