- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.04 / $3,655.50 / $8,006.50
| Facility | | $1,042.04 | $3,655.50 | $8,006.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.75 / $1,284.42 / $2,188.39
| Professional | | $801.75 | $1,284.42 | $2,188.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,944.00 / $11,253.00
| Facility | | $3,302.10 | $5,944.00 | $11,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.38 / $1,472.70 / $2,279.83
| Professional | | $919.38 | $1,472.70 | $2,279.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.91 / $1,951.00 / $2,059.40
| Facility | | $1,534.91 | $1,951.00 | $2,059.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.17 / $1,519.15 / $2,667.10
| Professional | | $945.17 | $1,519.15 | $2,667.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.00 / $5,179.50 / $9,716.00
| Facility | | $2,293.00 | $5,179.50 | $9,716.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.29 / $1,760.31 / $3,074.23
| Professional | | $1,338.29 | $1,760.31 | $3,074.23 |