- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.71 / $4,908.03 / $10,492.00
| Facility | | $1,698.71 | $4,908.03 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.33 / $1,313.34 / $2,223.61
| Professional | | $1,135.33 | $1,313.34 | $2,223.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,920.00 / $17,708.53 / $24,096.87
| Facility | | $9,920.00 | $17,708.53 | $24,096.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,299.61 / $2,036.51 / $2,886.73
| Professional | | $1,299.61 | $2,036.51 | $2,886.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.77 / $1,968.82 / $3,059.09
| Professional | | $1,329.77 | $1,968.82 | $3,059.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.00 / $5,345.00 / $14,963.00
| Facility | | $3,275.00 | $5,345.00 | $14,963.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.16 / $1,570.35 / $2,974.60
| Professional | | $1,087.16 | $1,570.35 | $2,974.60 |