- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.47 / $4,010.08 / $8,261.23
| Facility | | $1,227.47 | $4,010.08 | $8,261.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.81 / $1,073.69 / $1,888.75
| Professional | | $943.81 | $1,073.69 | $1,888.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,200.00 / $12,274.00
| Facility | | $3,877.00 | $7,200.00 | $12,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.46 / $1,234.49 / $1,942.32
| Professional | | $930.46 | $1,234.49 | $1,942.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,986.83 / $4,986.83 / $5,459.32
| Facility | | $4,986.83 | $4,986.83 | $5,459.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.62 / $1,412.48 / $2,219.36
| Professional | | $975.62 | $1,412.48 | $2,219.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.32 / $1,295.35 / $2,163.02
| Professional | | $950.32 | $1,295.35 | $2,163.02 |