- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $11,481.54
| Facility | | $1,862.09 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,754.23 / $5,128.61
| Professional | | $2,290.87 | $2,754.23 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $22,387.21
| Facility | | $3,981.07 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,884.03 / $5,370.32
| Professional | | $2,089.30 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,365.16 / $10,000.00
| Facility | | $398.11 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,467.37 / $6,918.31
| Professional | | $2,137.96 | $3,467.37 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $5,248.07
| Professional | | $2,137.96 | $2,951.21 | $5,248.07 |