- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.84 / $4,325.50 / $9,109.84
| Facility | | $1,422.84 | $4,325.50 | $9,109.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.74 / $1,273.82 / $1,904.33
| Professional | | $1,087.74 | $1,273.82 | $1,904.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,166.00 / $12,274.00
| Facility | | $3,877.00 | $7,166.00 | $12,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.85 / $1,425.66 / $2,258.56
| Professional | | $1,104.85 | $1,425.66 | $2,258.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.92 / $3,661.16 / $4,262.52
| Facility | | $3,072.92 | $3,661.16 | $4,262.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.32 / $1,639.48 / $2,606.96
| Professional | | $1,128.32 | $1,639.48 | $2,606.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,478.00 / $6,450.00 / $11,869.99
| Facility | | $3,478.00 | $6,450.00 | $11,869.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.10 / $1,531.35 / $2,641.95
| Professional | | $1,077.10 | $1,531.35 | $2,641.95 |