- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.16 / $4,733.50 / $9,248.34
| Facility | | $1,683.16 | $4,733.50 | $9,248.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,494.94 / $1,751.32 / $2,031.35
| Professional | | $1,494.94 | $1,751.32 | $2,031.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $9,324.00 / $17,206.00
| Facility | | $4,568.00 | $9,324.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.16 / $2,638.76 / $4,547.55
| Professional | | $914.16 | $2,638.76 | $4,547.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,253.97 / $8,253.97 / $8,724.50
| Facility | | $8,253.97 | $8,253.97 | $8,724.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,312.75 / $3,312.75 / $3,527.60
| Professional | | $3,312.75 | $3,312.75 | $3,527.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.17 / $2,684.12 / $4,670.37
| Professional | | $1,757.17 | $2,684.12 | $4,670.37 |