- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,179.51 / $4,149.72 / $7,879.32
| Facility | | $2,179.51 | $4,149.72 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,018.57 / $2,395.69 / $3,435.49
| Professional | | $2,018.57 | $2,395.69 | $3,435.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $7,537.12 / $12,695.35
| Facility | | $3,671.00 | $7,537.12 | $12,695.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.03 / $2,656.83 / $4,621.26
| Professional | | $2,073.03 | $2,656.83 | $4,621.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $785.00 / $2,598.36
| Facility | | $680.00 | $785.00 | $2,598.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.81 / $3,039.04 / $5,144.29
| Professional | | $2,031.81 | $3,039.04 | $5,144.29 |
- 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
- $1,985.38 / $2,702.98 / $4,918.27
| Professional | | $1,985.38 | $2,702.98 | $4,918.27 |