- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.77 / $3,725.88 / $7,879.32
| Facility | | $1,604.77 | $3,725.88 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.09 / $1,690.46 / $2,529.67
| Professional | | $1,462.09 | $1,690.46 | $2,529.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,610.55 / $11,344.00 / $22,985.21
| Facility | | $4,610.55 | $11,344.00 | $22,985.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.67 / $2,163.29 / $3,280.84
| Professional | | $1,518.67 | $2,163.29 | $3,280.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,795.73
| Facility | | $680.00 | $870.49 | $1,795.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.85 / $2,264.52 / $3,796.80
| Professional | | $1,541.85 | $2,264.52 | $3,796.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.26 / $2,059.29 / $3,539.76
| Professional | | $1,466.26 | $2,059.29 | $3,539.76 |