- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,762.13 / $9,062.00 / $18,276.00
| Facility | | $3,762.13 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,934.21 / $3,407.93 / $4,519.57
| Professional | | $2,934.21 | $3,407.93 | $4,519.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,033.46 / $3,449.08 / $5,197.43
| Professional | | $3,033.46 | $3,449.08 | $5,197.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $890.00 / $3,714.84
| Facility | | $715.00 | $890.00 | $3,714.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,462.02 / $4,324.51 / $7,270.32
| Professional | | $3,462.02 | $4,324.51 | $7,270.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.54 / $4,429.46 / $7,216.23
| Facility | | $3,392.54 | $4,429.46 | $7,216.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.50 / $2,333.00 / $4,343.91
| Professional | | $377.50 | $2,333.00 | $4,343.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,702.92 / $3,444.92 / $7,397.41
| Professional | | $2,702.92 | $3,444.92 | $7,397.41 |