- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,099.96 / $3,780.50 / $7,879.32
| Facility | | $2,099.96 | $3,780.50 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.54 / $2,360.21 / $3,829.79
| Professional | | $2,017.54 | $2,360.21 | $3,829.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,184.00 / $29,541.81
| Facility | | $7,754.10 | $16,184.00 | $29,541.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.97 / $2,838.05 / $4,633.84
| Professional | | $2,128.97 | $2,838.05 | $4,633.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,000.00 / $2,651.88
| Facility | | $900.00 | $1,000.00 | $2,651.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,278.96 / $3,207.29 / $5,091.00
| Professional | | $2,278.96 | $3,207.29 | $5,091.00 |
- 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
- $2,061.90 / $2,894.03 / $5,007.10
| Professional | | $2,061.90 | $2,894.03 | $5,007.10 |