- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.67 / $3,852.49 / $7,998.41
| Facility | | $1,997.67 | $3,852.49 | $7,998.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.88 / $2,112.86 / $3,300.60
| Professional | | $1,860.88 | $2,112.86 | $3,300.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $16,401.00 / $29,216.95
| Facility | | $8,512.20 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,026.58 / $2,888.78 / $4,701.34
| Professional | | $2,026.58 | $2,888.78 | $4,701.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,326.54
| Facility | | $895.00 | $950.00 | $2,326.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,126.80 / $3,131.19 / $4,641.82
| Professional | | $2,126.80 | $3,131.19 | $4,641.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.53 / $2,842.15 / $4,722.14
| Professional | | $1,947.53 | $2,842.15 | $4,722.14 |