- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.51 / $4,252.36 / $8,572.13
| Facility | | $2,016.51 | $4,252.36 | $8,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,727.63 / $2,106.69 / $3,216.67
| Professional | | $1,727.63 | $2,106.69 | $3,216.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $18,409.41 / $39,007.80
| Facility | | $4,586.00 | $18,409.41 | $39,007.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,680.61 / $2,352.72 / $3,997.24
| Professional | | $1,680.61 | $2,352.72 | $3,997.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,322.98
| Facility | | $895.00 | $950.00 | $2,322.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.42 / $2,672.47 / $4,418.73
| Professional | | $1,466.42 | $2,672.47 | $4,418.73 |
- 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
- $1,284.17 / $2,398.67 / $4,416.33
| Professional | | $1,284.17 | $2,398.67 | $4,416.33 |