- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.05 / $3,131.75 / $7,879.32
| Facility | | $1,147.05 | $3,131.75 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.81 / $1,173.08 / $1,915.87
| Professional | | $1,044.81 | $1,173.08 | $1,915.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,070.11 / $15,967.00 / $28,048.48
| Facility | | $7,070.11 | $15,967.00 | $28,048.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.08 / $1,502.38 / $2,504.84
| Professional | | $1,157.08 | $1,502.38 | $2,504.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,409.80 / $1,989.82 / $4,853.14
| Facility | | $1,409.80 | $1,989.82 | $4,853.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.75 / $1,661.38 / $2,597.17
| Professional | | $1,166.75 | $1,661.38 | $2,597.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,689.00
| Facility | | $4,505.00 | $10,133.00 | $19,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.80 / $1,499.28 / $2,569.48
| Professional | | $1,022.80 | $1,499.28 | $2,569.48 |