- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.16 / $3,904.04 / $7,879.32
| Facility | | $1,939.16 | $3,904.04 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,780.30 / $2,090.84 / $3,030.29
| Professional | | $1,780.30 | $2,090.84 | $3,030.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.84 / $8,947.00 / $14,433.40
| Facility | | $4,114.84 | $8,947.00 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.65 / $2,354.75 / $4,009.54
| Professional | | $1,835.65 | $2,354.75 | $4,009.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,270.62
| Facility | | $680.00 | $870.49 | $2,270.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,867.08 / $2,740.81 / $4,698.66
| Professional | | $1,867.08 | $2,740.81 | $4,698.66 |
- 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
- $1,789.96 / $2,449.89 / $4,363.22
| Professional | | $1,789.96 | $2,449.89 | $4,363.22 |