- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.41 / $4,668.50 / $9,965.71
| Facility | | $2,103.41 | $4,668.50 | $9,965.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.09 / $2,181.52 / $2,596.67
| Professional | | $1,849.09 | $2,181.52 | $2,596.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $16,241.00 / $29,216.95
| Facility | | $8,512.20 | $16,241.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.48 / $2,275.07 / $3,772.65
| Professional | | $2,043.48 | $2,275.07 | $3,772.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,000.00 / $2,604.13
| Facility | | $900.00 | $1,000.00 | $2,604.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,328.93 / $6,328.93 / $10,842.01
| Professional | | $6,328.93 | $6,328.93 | $10,842.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,384.00
| Facility | | $1,185.00 | $3,269.00 | $7,384.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,109.12 / $3,026.99 / $5,032.32
| Professional | | $2,109.12 | $3,026.99 | $5,032.32 |