- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,118.71 / $4,668.50 / $9,767.50
| Facility | | $2,118.71 | $4,668.50 | $9,767.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.36 / $2,354.28 / $3,512.70
| Professional | | $1,944.36 | $2,354.28 | $3,512.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,790.00 / $20,084.50 / $59,050.00
| Facility | | $7,790.00 | $20,084.50 | $59,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.74 / $2,770.26 / $4,580.07
| Professional | | $2,128.74 | $2,770.26 | $4,580.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,653.28
| Facility | | $895.00 | $950.00 | $2,653.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,171.14 / $3,175.05 / $5,017.01
| Professional | | $2,171.14 | $3,175.05 | $5,017.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,858.50 / $9,857.00 / $19,279.50
| Facility | | $3,858.50 | $9,857.00 | $19,279.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.54 / $2,831.15 / $4,797.39
| Professional | | $1,983.54 | $2,831.15 | $4,797.39 |