- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.89 / $3,887.77 / $8,016.87
| Facility | | $1,993.89 | $3,887.77 | $8,016.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,856.98 / $2,115.69 / $3,295.03
| Professional | | $1,856.98 | $2,115.69 | $3,295.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,184.00 / $28,048.48
| Facility | | $7,754.10 | $16,184.00 | $28,048.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.00 / $2,828.18 / $4,611.53
| Professional | | $2,002.00 | $2,828.18 | $4,611.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,322.34
| Facility | | $895.00 | $950.00 | $2,322.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,122.91 / $3,125.77 / $4,626.71
| Professional | | $2,122.91 | $3,125.77 | $4,626.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,017.50 / $7,220.50 / $14,355.11
| Facility | | $3,017.50 | $7,220.50 | $14,355.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,906.56 / $2,804.90 / $4,610.06
| Professional | | $1,906.56 | $2,804.90 | $4,610.06 |