- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,959.67 / $4,147.50 / $8,561.00
| Facility | | $1,959.67 | $4,147.50 | $8,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,712.00 / $2,032.05 / $3,171.87
| Professional | | $1,712.00 | $2,032.05 | $3,171.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,068.50 / $10,923.00 / $22,453.48
| Facility | | $5,068.50 | $10,923.00 | $22,453.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,813.41 / $2,403.48 / $3,907.57
| Professional | | $1,813.41 | $2,403.48 | $3,907.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,252.73
| Facility | | $895.00 | $950.00 | $2,252.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,921.22 / $2,748.73 / $4,402.13
| Professional | | $1,921.22 | $2,748.73 | $4,402.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.83 / $2,450.89 / $4,315.22
| Professional | | $1,756.83 | $2,450.89 | $4,315.22 |