- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.28 / $4,443.50 / $8,572.13
| Facility | | $1,395.28 | $4,443.50 | $8,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.31 / $1,375.96 / $1,395.28
| Professional | | $1,089.31 | $1,375.96 | $1,395.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,271.00 / $19,794.66 / $48,414.52
| Facility | | $9,271.00 | $19,794.66 | $48,414.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.52 / $1,582.56 / $2,442.83
| Professional | | $1,305.52 | $1,582.56 | $2,442.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,000.00 / $1,555.88
| Facility | | $900.00 | $1,000.00 | $1,555.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.09 / $6,184.96 / $6,478.08
| Professional | | $2,734.09 | $6,184.96 | $6,478.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.00 / $7,100.00 / $14,468.00
| Facility | | $3,007.00 | $7,100.00 | $14,468.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.08 / $1,868.75 / $3,011.24
| Professional | | $1,215.08 | $1,868.75 | $3,011.24 |