- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.68 / $4,318.34 / $8,181.00
| Facility | | $1,522.68 | $4,318.34 | $8,181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.23 / $1,556.41 / $1,972.11
| Professional | | $1,265.23 | $1,556.41 | $1,972.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,518.00 / $6,548.00 / $10,517.23
| Facility | | $3,518.00 | $6,548.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.93 / $1,187.82 / $2,357.45
| Professional | | $186.93 | $1,187.82 | $2,357.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,241.01 / $2,241.01 / $2,848.12
| Facility | | $2,241.01 | $2,241.01 | $2,848.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,205.73 / $2,614.53 / $2,872.35
| Professional | | $2,205.73 | $2,614.53 | $2,872.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,920.00 / $9,810.00
| Facility | | $2,637.00 | $5,920.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,931.58 / $2,859.46 / $4,421.54
| Professional | | $1,931.58 | $2,859.46 | $4,421.54 |