- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,715.35 / $4,897.79
| Facility | | $2,344.23 | $3,715.35 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,630.27 / $4,466.84
| Professional | | $2,238.72 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $13,489.63 / $19,054.61
| Facility | | $6,456.54 | $13,489.63 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,398.83 / $3,801.89
| Professional | | $1,905.46 | $2,398.83 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,454.71 / $2,754.23
| Facility | | $2,344.23 | $2,454.71 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Professional | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,265.80 / $4,265.80
| Facility | | $758.58 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $4,677.35
| Professional | | $1,949.84 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,623.41 / $12,022.64
| Facility | | $1,023.29 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,630.27 / $4,073.80
| Professional | | $2,041.74 | $2,630.27 | $4,073.80 |