- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.99 / $4,064.03 / $7,879.32
| Facility | | $2,088.99 | $4,064.03 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,918.45 / $2,250.73 / $3,255.71
| Professional | | $1,918.45 | $2,250.73 | $3,255.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.84 / $8,805.92 / $14,433.40
| Facility | | $4,114.84 | $8,805.92 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,845.72 / $2,532.69 / $4,315.39
| Professional | | $1,845.72 | $2,532.69 | $4,315.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,445.40
| Facility | | $680.00 | $870.49 | $2,445.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,846.84 / $2,965.56 / $5,000.04
| Professional | | $1,846.84 | $2,965.56 | $5,000.04 |
- 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
- $1,929.84 / $2,641.38 / $4,743.39
| Professional | | $1,929.84 | $2,641.38 | $4,743.39 |