- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.51 / $3,724.07 / $7,879.32
| Facility | | $1,744.51 | $3,724.07 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.32 / $1,895.19 / $3,110.91
| Professional | | $1,641.32 | $1,895.19 | $3,110.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,184.00 / $28,048.48
| Facility | | $7,754.10 | $16,184.00 | $28,048.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,739.78 / $2,315.42 / $3,751.11
| Professional | | $1,739.78 | $2,315.42 | $3,751.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,142.73 / $2,142.73 / $4,890.73
| Facility | | $2,142.73 | $2,142.73 | $4,890.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.31 / $2,614.88 / $4,148.49
| Professional | | $1,869.31 | $2,614.88 | $4,148.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,384.00
| Facility | | $1,185.00 | $3,269.00 | $7,384.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,661.83 / $2,389.73 / $4,098.01
| Professional | | $1,661.83 | $2,389.73 | $4,098.01 |