- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,409.83 / $4,443.50 / $8,572.13
| Facility | | $2,409.83 | $4,443.50 | $8,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,162.54 / $2,585.46 / $3,941.23
| Professional | | $2,162.54 | $2,585.46 | $3,941.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $11,139.12 / $26,880.01
| Facility | | $4,586.00 | $11,139.12 | $26,880.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.86 / $2,959.29 / $4,892.59
| Professional | | $2,165.86 | $2,959.29 | $4,892.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,847.41
| Facility | | $895.00 | $950.00 | $2,847.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,214.42 / $3,414.94 / $5,552.45
| Professional | | $2,214.42 | $3,414.94 | $5,552.45 |
- 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
- $1,919.36 / $2,993.26 / $5,424.20
| Professional | | $1,919.36 | $2,993.26 | $5,424.20 |