- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.39 / $4,419.57 / $8,572.13
| Facility | | $2,187.39 | $4,419.57 | $8,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.22 / $2,229.53 / $3,925.28
| Professional | | $2,001.22 | $2,229.53 | $3,925.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,046.00 / $7,270.00 / $12,538.00
| Facility | | $4,046.00 | $7,270.00 | $12,538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,126.75 / $2,775.50 / $4,399.34
| Professional | | $2,126.75 | $2,775.50 | $4,399.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,000.00 / $2,486.26
| Facility | | $900.00 | $1,000.00 | $2,486.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,233.21 / $3,163.80 / $4,802.68
| Professional | | $2,233.21 | $3,163.80 | $4,802.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,283.50 / $6,724.50 / $11,831.32
| Facility | | $3,283.50 | $6,724.50 | $11,831.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,987.51 / $2,763.98 / $4,774.47
| Professional | | $1,987.51 | $2,763.98 | $4,774.47 |